As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) toInterQual.
This week’s Medicare updates include a notice about reprocessing certain drug claims that were rejected in error, the latest version of the Medicare beneficiary COVID-19 data snapshot, a table on MAC pricing for COVID-19 testing, and more!
In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of our 2020 Coding Productivity Survey. Learn how facilities adapted and how yours compares.
Organizations continue to struggle with denials for conditions such as sepsis and pneumonia. Review your processes and then apply these expert tips to help turn the tide.
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
The HIM department plays a critical role in the revenue cycle, but it’s often placed in a reactive position, limiting its effectiveness. Learn how to improve operations by enhancing the HIM department’s involvement across the revenue cycle.
