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AppriseMD Blog
The Centers for Medicare and Medicaid Services’ decision to not eliminate the inpatient only list (IPO) was due to the numerous comments and feedback it received from the medical community, the COVID-19 public health emergency and the fact that the change “transpired quickly,” according to the final rule (CMS-1753FC) issued in December.1 Heading into 2022, […]
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 […]