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AppriseMD Blog

P2P Review for Multiple Sclerosis Case

Case Study: Multiple Sclerosis Inpatient Stay Denial Upheld

By AppriseMD | March 16, 2022 | Comments Off on Case Study: Multiple Sclerosis Inpatient Stay Denial Upheld

Determining level of care as a live case review can be difficult when doctors are still waiting on imaging and deciding upon treatment plans. One such live case review involved a patient with multiple sclerosis as detailed here, which AppriseMD recommended for inpatient level of care. The insurance company denied the inpatient stay. After completing […]

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

Doctors work on a patient in the Emergency Department

Case Study: New DRG Key to Overturning MCO Denial

By AppriseMD | September 25, 2025 | Comments Off on Case Study: New DRG Key to Overturning MCO Denial

CLINICAL SUMMARY: A 34-year-old patient arrived in the emergency department (ED) experiencing complications from alcohol withdrawal, which began while staying at a sober living home. He began experiencing lightheadedness, nausea, vomiting and epigastric pain in addition to developing a bilateral rash to his upper extremities and was transported to the ED. The patient reported drinking […]

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