The variety of sources for commercial insurance requirements can present challenges to the utilization review (UR) specialist, as UR rules for every patient could differ depending on his or her insurance and that insurer’s policies. Apply these lessons to help UR manage commercial insurance requirements.
Jessie, a nurse case manager, feels healthcare has changed since the beginning of the pandemic. She believes that the greatest change comes from the recent initiation of new healthcare coverage plans, primarily Medicaid managed care and Medicare Advantage.
Directors are searching for solutions to the healthcare staffing shortage. Could one of them involve changing your leadership style to boost outcome achievement?
Many case managers use remote patient monitoring (RPM) to ease the pinch of staffing shortages and help to prevent readmissions. But some are warning that the accessibility of those services may be threatened by one of numerous changes in the 2023 Medicare Physician Fee Schedule proposed rule—a proposed 12% reimbursement reduction for RPM CPT® code 99454.
In August, the Office for Civil Rights (OCR) announced a settlement with New England Dermatology P.C., known as New England Dermatology and Laser Center, over the improper disposal of PHI, which is a potential HIPAA Privacy Rule violation.
