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AppriseMD Blog

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 […]

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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