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.
This week’s Medicare updates include an announcement on expanded payments for at-home COVID-19 vaccinations, dates for implementation of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transports nationwide, an OIG review of phlebotomy travel allowances, and more!
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.
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.
