Many case management and finance departments have been busy with appeal activities since CMS resumed its regulatory audits on August 3, 2020. Utilization review (UR) nurses are reporting increasing numbers of commercial denials as the coronavirus (COVID-19) pandemic is resolving.
Q: One of the biggest challenges for case management directors is gaining the physician’s cooperation with documentation as they continue to face high patient volumes. What approaches should be taken to get physicians on the same page as case management directors?
CMS should rescind denials recently issued to certain off-campus provider-based departments (PBD) that applied for the mid-build exception under the 21st Century Cures Act, the AHA said in a March 25 letter to CMS.
