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.
Audits are ramping up across the country, creating additional headaches for many healthcare organizations as they simultaneously struggle with the delta variant of COVID-19.
CMS walked back some major policy changes and cemented others in the 2022 Inpatient Prospective Payment System (IPPS) final rule. Brush up on the latest changes and ensure your hospital is ready to comply by October 1.
