Short Stay

Blood work for DKA testing

Case Study: Short Stay Common Diabetic Ketoacidosis Denial Overturned

Case Study, Denial Management, Peer-to-Peer / By

Can hospitals receive full inpatient admission reimbursement for a patient experiencing diabetic ketoacidosis who only spends one night in the hospital? AppriseMD’s latest case study shows that it is possible. A young adult patient with type 1 diabetes struggling with consistent vomiting over two weeks stayed one night as a hospital inpatient, but commercial insurance […]

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Empty hospital bed

Case Study: AMA Inpatient Denial Overturned

Case Study, Denial Management, Peer-to-Peer / By

CLINICAL SUMMARY: A 75-year-old male arrived at the Emergency Department with fevers, body aches, shortness of breath and chills. The patient had a medical history of Type 2 diabetes, hypertension and chronic urinary retention for which he self-catheterized. Additionally, the patient had diabetic peripheral neuropathy being treated with gabapentin, and he presented with elevated creatinine,

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PA secondary reviews raise reimbursement

Case Study: Physician Advisor Secondary Review Insight on MA Case

Case Study, Denial Management, Medicare, Two-Midnight Rule / By

CLINICAL SUMMARY: An 88-year-old patient with a complex cardiac history of chronic congestive heart failure and dilated cardiomyopathy arrived at the emergency department (ED) with worsening shortness of breath and intermittent dizziness. The patient’s medical history included COPD, dilated cardiomyopathy, ventricular tachycardia with implantable cardioverter-defibrillator (ICD) shocks, atrial fibrillation (for which the patient uses Eliquis®),

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CMS IPO 2024

Case Study: IPO List Proves Critical in Overturning Denied Inpatient Stay

Case Study, Denial Management, Inpatient Only List, Medicare / By

AppriseMD physician advisors overturned a denied inpatient stay for a myomectomy by discussing this procedure’s placement on the inpatient-only IPO list, which is for surgeries that are considered high risk. Even though the patient was discharged on the day of surgery, this reversal shows the importance of peer-to-peer discussions conducted by physician advisors with regulatory

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Patient being treated in the hospital

Case Study: Denial Reversed in Short Stay Alcohol-Induced Pancreatitis Admission

Case Study, Denial Management / By

CLINICAL SUMMARY: A 30-year-old patient arrived at the emergency room suffering from abdominal pain, nausea and vomiting. The patient’s symptoms had been occurring for the past six weeks and progressively worsened. The patient complained of pain in the upper abdomen that radiated to the back. The patient had a medical history of anxiety, asthma, depression,

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Overnight short-stay denial reversed in AppriseMD case study.

Case Study: Overnight Short-Stay Denial Reversed

Case Study, Denial Management, Length of Stay, Peer-to-Peer / By

CLINICAL SUMMARY: A 50-year-old patient was hospitalized overnight after arriving in the emergency room with constant left flank pain. The patient was seen in the emergency room (ER) the previous week with similar symptoms, which doctors diagnosed as a 5 mm, left proximal ureteral stone with mild hydroureteronephrosis. The patient was treated and sent home

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Physician advisors with hospital-based clinical experience combined with utilization management experience, can bring when it comes to reversing short stay denials.

Case Study: Medical Necessity Behind Short Stay is Key

Case Study, Denial Management / By

CLINICAL SUMMARY: Medical Necessity Behind Short Stay is Key This case involves a one-day inpatient denial for a 30-year-old patient treated for acute pancreatitis. With abdominal pain and nausea, the patient went to the Emergency Department where he was found to have upper abdominal pain and tenderness, a lipase of 1,447 U/L (reference range 16-77

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Determining observation stay guidelines

Which Guidelines Should Hospitals Follow for an Observation Stay?

Blog, Length of Stay, Utilization Review / By

Both national evidence-based guidelines and insurance company guidelines factor into level of care determination.   When it comes to determining a patient’s level of care for a short hospital stay, observation services are generally used for short-term monitoring, testing and evaluation to establish a treatment plan, and to give the treatment team time to see

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