STAY APPRISED!
Join the ApprisedMD mailing list to receive case studies and papers.
Follow AppriseMD
AppriseMD Blog
Hospitals and health systems across the country are preparing for a significant shift in how Aetna reimburses certain inpatient stays. Aetna’s Level of Severity Inpatient Payment Policy, which went into effect January 1, 2026, (updated from the original effective date of November 15, 2025) introduced a new framework for evaluating and reimbursing urgent or emerging […]
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
THE CHALLENGE Many hospitals and health systems have been forced to navigate a new payer tactic that does not result in a formal denial of inpatient (IP) level of care (LOC). Instead, the payer affirms that IP admission was medically necessary, but reimbursement is reduced due to a perceived lack of severity for the billed […]