The variety of sources for commercial insurance requirements can present challenges to the utilization review (UR) specialist, as UR rules for every patient could differ depending on his or her insurance and that insurer’s policies. Apply these lessons to help UR manage commercial insurance requirements.
In early June, Congress released a bipartisan draft bill called the American Data Privacy and Protection Act. The goal of this bill is to create a regulation that organizations in any industry would need to accord with compliance. On the surface, this sounds great, but in reality, it is unrealistic.
This week’s Medicare updates include new items added to the OIG Work Plan, an extension for certain payment rate adjustments for low volume and Medicare dependent hospitals, and more!
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
Many case managers use remote patient monitoring (RPM) to ease the pinch of staffing shortages and help to prevent readmissions. But some are warning that the accessibility of those services may be threatened by one of numerous changes in the 2023 Medicare Physician Fee Schedule proposed rule—a proposed 12% reimbursement reduction for RPM CPT® code 99454.
