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.
Directors are searching for solutions to the healthcare staffing shortage. Could one of them involve changing your leadership style to boost outcome achievement?
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.
This week’s Medicare updates include a notice about how CMS is planning to handle payments for 340B drugs for the rest of the year, an update to the ambulance inflation factor for 2023, the notice of the new interest rate for Medicare overpayments and underpayments, and more!
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.
