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.
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.
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.
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.
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.
As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) toInterQual.
