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Case managers must begin to learn the skill of brokering for care. The goal of private payers is to provide the most cost-effective care that meets medical necessity for services and increases likelihood for recovery. 

What is a good strategy for sharing denials data with the medical staff to ensure they understand weaknesses?

What is the weakest/worst-case scenario for the structure of a case management department?

Q: Is it appropriate to query whether a pressure ulcer was present on admission (POA) if it was not documented until later in the admission?

Q: We are revamping our coding department at our facility after acquiring new sites and wanted to know what types of positions and roles our staff should have. Do you have any advice?

The U.S. House passed the Overdose Prevention and Patient Safety Act (HR 6082) on June 20 to amend the Public Health Service Act and protect the confidentiality of substance use disorder (SUD) patient records.

Q: Does sending a generic “happy birthday” postcard to patients during their birthday month violate HIPAA rules?

The nearly 30-year-old Stark Law could be due for an overhaul, according to CMS. The agency is requesting public feedback on how to streamline the law’s administrative requirements and retool it to better fit with modern alternative payment models and value-based care.

Q: How do we know if our facility is performing too many patient tests? What can we do to prove the tests are medically necessary?

Around a dozen employees of the Washington Health System (WHS) in Washington County, Pennsylvania, have reportedly been suspended for HIPAA violations involving alleged inappropriate access to patient records, according to the Washington County Observer-Reporter.