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.
This week's note from the instructor discusses CMS' proposal in the CY 2022 OPPS proposed rule to reverse course on CY 2021 changes to the inpatient-only list and the ambulatory surgical center covered procedures list.
Anna, a case manager who practices in a pulmonologist’s office, manages adult high-risk asthmatic patient care. The office serves more than 2,000 patients, which Anna learns is the upper range of average. She recently learned that the American Association for Physician Leadership believes that a physician’s office can successfully handle a volume of 3,000 patients.
Outpatient coding for injections and infusions can be challenging given the foundational definitions and complex rules that drive reporting of these services. This article breaks down the facility drug administration hierarchy and CPT coding for therapeutic infusions, injections, and hydration.
Nonprofit hospitals are falling short when it comes to completing community needs assessments required under the Patient Protection and Affordable Care Act, according to an August research letter published by JAMA Network Open.
HHS recently issued its Summer 2021 OCR Cybersecurity Newsletter, covering the topic of controlling access to ePHI. HHS officials cited a Verizon 2021 Data Breach Investigations report that found 61% of analyzed data breaches in the healthcare sector were perpetrated by external threat actors and 39% were carried out by insiders.
