STAY APPRISED!
Join the ApprisedMD mailing list to receive case studies and papers.
Follow AppriseMD
AppriseMD Blog
CLINICAL SUMMARY: A 73-year-old patient’s primary care doctor sent her to the Emergency Department (ED) after multiple labs taken for continuing chest pains showed abnormal results. The patient, who had been suffering chest pain for more than a week and who was taking nitroglycerin, had a stent placed in April. The patient had an extensive […]
White Papers
The financial impact of the IPO list magnified with the rise of CMS-4201-F, giving rise to inpatient reimbursement for all MAO patients who require services designated on the IPO list. Hospitals need to ensure that the proper setting is scheduled when any Medicare or MA patient undergoes a procedure designated on the IPO list, and they should also follow any proposed additions and removals to the list closely to ensure appropriate treatment and reimbursement.
Case Studies
EXECUTIVE SUMMARY A commercial payer denied a one-day inpatient (IP) admission for a teenage patient with sepsis secondary to acute appendicitis, despite evidence of significant illness and operative findings of peritonitis. The denial placed a substantial amount of IP reimbursement at risk. Following the physician-led peer-to-peer (P2P) review, the denial was overturned and appropriate reimbursement […]