This week's instructor note dives into the recent instruction from CMS on requirements for reporting a COVID-19 diagnosis on a claim in order for the claim to be eligible for a payment increase.
Q: If a person has a history of substance abuse, but at the time of admission appears to be of sound mind, is that patient’s personal representative still entitled to receive information about the patient’s treatment and status?
CMS extended the education and operations testing period for the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging through 2021. The education and operations testing period, which started January 1, 2020, was slated to close at the end of the year.
Determining which denials could be overturned on appeal is key to a successful denial management program. Learn how to leverage your appeal team's knowledge to create a data-driven scoring system.
This week’s Medicare updates include new guidance on elective procedures for end-stage renal disease patients during the public health emergency, new additions to the OIG work plan, updated data on opioid use in Medicare Part D, and more!
Q: As utilization review case managers, we are often tasked with assessing our hospital's risk for novel coronavirus (COVID-19) denials. What are the most important measures we should be examining?
