Is the inpatient-only list soon to be a thing of the past? It’s possible. In the 2021 OPPS proposed rule, released August 3, CMS suggested that there is no longer a need for the inpatient-only list. Instead, CMS recommended deferring to the physician’s clinical judgment.
Q: While telemedicine is becoming ubiquitous, we must face the reality that not every patient is capable of effectively accessing or utilizing these tools. What are your suggestions for helping these patients?
Last month, Case Management Monthly provided tips to help support patients using technology during the novel coronavirus (COVID-19) pandemic. Since then, the Journal of the American Medical Association (JAMA) published a research letter underscoring the need for this support.
Matty, an expert utilization review (UR) case manager, is shocked when she receives a letter denying payment for the entire hospital stay of Michael, who has recovered after falling severely ill with the novel coronavirus (COVID-19).
Case managers use a lot of lists. They use lists of nursing homes, lists of community organizations, and lists of other resources that are designed to help their patients.
But there are times when a list is not the best option, saysDiane Iverson, RN, BSN, BS, ACM, CCM, a Baltimore-area case manager. For example, when case managers are working with individuals seeking assistance for substance use disorders, lists of resources may not be effective.
Q: As utilization review case managers, we are often tasked with assessing our hospital's risk for novel coronavirus (COVID-19) denials. What are the most important measures we should be examining?
