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?
Q: Many organizations have outsourced their PHI disposal for years. With coronavirus limiting the number of people coming in and out of medical facilities, what are your suggestions for organizations that now have to take care of PHI disposal themselves? What are the most important things to remember when handling this process?
Case management directors and utilization review (UR) case managers beware! In a Frequently Asked Questions (FAQ) document released in July, CMS said it expects to discontinue enforcement discretion for Medicare fee-for-service medical reviews beginning August 3, regardless of the status of the public health emergency (PHE).
