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.
HHS recently issued its Summer 2021 OCR Cybersecurity Newsletter, covering the topic of controlling access to ePHI. HHS officials cited a Verizon 2021 Data Breach Investigations report that found 61% of analyzed data breaches in the healthcare sector were perpetrated by external threat actors and 39% were carried out by insiders.
CMS has reinstated the short-stay reviews and high-weighted DRG reviews originally halted in 2019. The national contract to conduct these reviews was awarded to Livanta, one of the Beneficiary & Family-Centered Care and Quality Improvement Organizations.
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.
