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AppriseMD Blog

Patient in ER for cellulitis

Case Study: Secondary Review Recommendation Holds in Cellulitis Hospitalization

By AppriseMD | October 27, 2025 | 0 Comments

CLINICAL SUMMARY: A 35-year-old patient arrived in the Emergency Department suffering from a painful abscess and swelling on the left buttock. The patient, whose medical history includes hidradenitis suppurativa, bipolar 1 disorder and asthma, described the pain as an excruciating stabbing sensation rated at a level 10. Furthermore, the patient reported shortness out of breath […]

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

CS-chest-pain-non-cardiac denial overturned

Case Study: Chest Pain, Non-cardiac Can be Difficult to Get Admission Status Correct

By AppriseMD | February 9, 2022 | Comments Off on Case Study: Chest Pain, Non-cardiac Can be Difficult to Get Admission Status Correct

Chest pain is one of the most common ER diagnoses. For those patients who require hospital admission, getting the admission status correct and paid by the insurance company can be tricky. One such case involved a patient who arrived in the ER with chest pain presumed due to unstable angina (TIMI 3). The patient was […]

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