News & Analysis

October 1, 2010
Case Management Monthly

To begin to think about separating the UR function from the case management role, you must question the validity of the functional model

October 1, 2010
Case Management Monthly

Several case managers have recently received denial letters from their regions’ Medicare Advantage (MA) for medically necessary readmissions.

October 1, 2010
Case Management Monthly

Teaching noncompliant patients how to cheat seems counterproductive, but this strategy saved lives in one medical center’s renal patient population.

October 1, 2010
Case Management Monthly

One setting alone doesn’t possess all the services required to fulfill a patient’s needs. Employees at each setting have different talents, skills, and knowledge needed to achieve all the care needs.

September 1, 2010
HIM Briefings

One of the most important aspects of documenting your evaluation and treatment of inpatients in the medical record is providing the verbiage that meets your goals for describing your patient. When you provide the right words, the coders assign the right codes.

September 1, 2010
HIM Briefings

The electronic Program for Evaluating Payment Patterns Electronic Report (PEPPER) contains data for hospitals on MS-DRGs and discharges at high risk for payment errors. Per the opening paragraph of the 2010 PEPPER User’s Guide:

As part of a compliance program, a hospital should conduct regular audits to ensure charges for Medicare services are correctly documented and billed. PEPPER can help guide the hospital’s auditing and monitoring activities.

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