News & Analysis

September 8, 2021
HIM Briefings

UnitedHealthcare recently transitioned its utilization management approach for all of its health plans from Milliman Care Guidelines to InterQual criteria. Learn how this change could have far-reaching impact on hospitals.

September 1, 2021
Case Management Monthly

As the country sees a resurgence of COVID-19 thanks to the delta variant, hospitals are seeing an increase not only in their immediate census numbers, but also in the number of readmissions.

July 1, 2021
Case Management Monthly

A policy that UnitedHealthcare was poised to roll out that would have allowed it to retroactively deny ED claims isn’t moving forward yet. But that doesn’t mean case managers shouldn’t prepare for the payer, or others, to implement such policies.

July 1, 2021
Case Management Monthly

CMS announced another round of changes to its Bundled Payments for Care Improvement program recently and said that while participation thus far has been voluntary, it may become mandatory starting as early as 2024.

June 1, 2021
Case Management Monthly

Ensuring patients are being treated with the right level of care helps facilities allocate resources appropriately and keeps costs lower for patients and health systems.

May 1, 2021
Case Management Monthly

Inpatient or observation? Making this decision remains a considerable challenge at many hospitals—and when they get it wrong, it can also be a costly one.

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