UnitedHealthcare (UHC) is suspending certain prior authorization requirements for in-network hospitals and skilled nursing facilities through January 31.
Organizations continue to struggle with denials for conditions such as sepsis and pneumonia. Review your processes and then apply these expert tips to help turn the tide.
Q: Throughout the novel coronavirus (COVID-19) pandemic, case managers have faced many challenges when trying to find placements for patients who need to transfer from the hospital to a lower level of care, such as a skilled nursing facility (SNF). As we enter 2021, what challenges will persist and how can case managers work to overcome them?
Q: We're seeing a significant increase in pre-payment audit activity. How can we adapt our audit and denial management processes to cope with this shift?
As many anticipated, the Department of Health and Human Services (HHS) has pushed out a flurry of proposed rules in the months leading up to the Trump administration’s departure. Among them is a Notice of Proposed Rulemaking (NPRM) that would make significant changes to the HIPAA Privacy Rule.
It’s safe to say few people are sad to see 2020 go. The question is, what will 2021 bring? To help you prepare for what the new year may bring, we asked some experts for their predictions and recommendations on what case managers might expect and prepare to focus on in 2021.
