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AppriseMD Blog
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
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 […]