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AppriseMD Blog
Both national evidence-based guidelines and insurance company guidelines factor into level of care determination. When it comes to determining a patient’s level of care for a short hospital stay, observation services are generally used for short-term monitoring, testing and evaluation to establish a treatment plan, and to give the treatment team time to see […]
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 […]