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AppriseMD Blog
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
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 […]