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AppriseMD Blog

AppriseMD physician advisors provide essential utilization review and denial management services to hospitals

How Does the Two-Midnight Rule Apply When a Traditional Medicare Patient Has No Safe Discharge Plan?

By AppriseMD | February 14, 2022 | Comments Off on How Does the Two-Midnight Rule Apply When a Traditional Medicare Patient Has No Safe Discharge Plan?

For a traditional Medicare patient admitted for observation, it is not uncommon to remain in the hospital longer than two midnights due to non-medical reasons including waiting for a transfer to another facility or family situations. In these cases, the reason the patient remains hospitalized is the lack of a safe discharge plan. Should such […]

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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