Matty, an expert utilization review (UR) case manager, is shocked when she receives a letter denying payment for the entire hospital stay of Michael, who has recovered after falling severely ill with the novel coronavirus (COVID-19).
Case managers use a lot of lists. They use lists of nursing homes, lists of community organizations, and lists of other resources that are designed to help their patients.
But there are times when a list is not the best option, saysDiane Iverson, RN, BSN, BS, ACM, CCM, a Baltimore-area case manager. For example, when case managers are working with individuals seeking assistance for substance use disorders, lists of resources may not be effective.
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?
Finding the right applicant to fill a vacancy in the coding department can be challenging. Organizations can help close the gap and improve their coding staff by implementing an apprentice program. Use this sample education schedule to help develop a program at your organization.
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.
