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AppriseMD Blog

Case Study: Secondary Review Recommendation Holds in Cellulitis Hospitalization

By AppriseMD | October 27, 2025 | Comments Off on Case Study: Secondary Review Recommendation Holds in Cellulitis Hospitalization

CLINICAL SUMMARY: A 35-year-old patient arrived in the Emergency Department suffering from a painful abscess and swelling on the left buttock. The patient, whose medical history includes hidradenitis suppurativa, bipolar 1 disorder and asthma, described the pain as an excruciating stabbing sensation rated at a level 10. Furthermore, the patient reported shortness out of breath […]

White Papers

IPO List Compliance a whte paper from AppriseMD

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

Case Study: Infant Failure to Thrive Inpatient Denial Overturned

By AppriseMD | January 15, 2026 | Comments Off on Case Study: Infant Failure to Thrive Inpatient Denial Overturned

CLINICAL SUMMARY: A newborn infant, just over one-month-old, arrived at the Emergency Department (ED) under the direction of a pediatrician, who was concerned about lack of weight gain since birth. The infant was born weighing 8 pounds, 5 ounces and weighed 8 pounds, 5.5 ounces one month and five days after birth. The patient’s weight […]

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