Case managers are overburdened and understaffed in hospitals across the country. With a tight job market, it’s likely that the crunch won’t lessen any time soon, so many organizations are looking to increase efficiency to ensure that they continue to meet the needs of their patients.
Tiffany Ferguson, LMSW, ACM, and Marie Stinebuck, MBA, MSN, ACM, CEO and COO at Phoenix Medical Management Inc., discuss why the best strategy to prevent denials related to medical necessity is a proactive approach that focuses on front-end processes.
The Important Message from Medicare (IM) Form-CMS-10065 is a document designed to inform hospitalized patients receiving inpatient services of their discharge appeal rights.
As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) toInterQual.
Interventions to reduce length of stay for high-risk, medically complex, and otherwise vulnerable patients are falling short, according to a technical brief prepared for the Agency for Healthcare Research and Quality.
As the country sees a resurgence of COVID-19 thanks to the delta variant, hospitals are seeing an increase not only in their immediate census numbers, but also in the number of readmissions.
UnitedHealthcare recently transitioned its utilization management approach for all of its health plans from Milliman Care Guidelines to InterQual criteria. Learn how this change could have far-reaching impact on hospitals.
A policy that UnitedHealthcare was poised to roll out that would have allowed it to retroactively deny ED claims isn’t moving forward yet. But that doesn’t mean case managers shouldn’t prepare for the payer, or others, to implement such policies.
CMS announced another round of changes to its Bundled Payments for Care Improvement program recently and said that while participation thus far has been voluntary, it may become mandatory starting as early as 2024.
Ensuring patients are being treated with the right level of care helps facilities allocate resources appropriately and keeps costs lower for patients and health systems.
