Q: I’m working with our contracting staff to negotiate with a new payer. Is there any potentially problematic contract language I should take under further review?
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
If you’re involved in utilization review and have found yourself in the uncomfortable position of having to tell a doctor that a patient doesn’t meet criteria for an inpatient stay, you may want to consider different ways to approach these conversations.
Q: I am an acupuncturist and have a patient who owes me $100. I contacted the patient about the missing payment but received no response. Would it be a HIPAA violation to get in touch with the patient’s emergency contact person about the missing payment? Or should I go to a debt collector?
A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
