Mr. A suffered a cerebrovascular accident, which has affected his ability to comprehend and communicate. Mr. A needs someone to consent for percutaneous endoscopic gastrostomy placement, but he lacks the capacity for decision-making, as certified by two physicians.
Does case management need to be a seven-day-a-week service, or can the service succeed with coverage five days per week? As a case manager, I need to retain staff but also provide some consistency to the patients.
An audit of Medicare Part B payments from 2014 through 2016 revealed that CMS improperly paid providers more than $66.3 million for specimen validity tests billed in combination with urine drug tests, according to a report by the OIG.
CMS’ Chronic Care Management service is aimed at strengthening access to chronic care management services in primary care settings while reducing costs, and a report on the program prepared by Mathematica Policy Research for CMS indicates its doing just that.
Q: Our facility does not have a standard appeal letter template to respond to medical necessity denials. Do you have any suggestions for how to respond?
Electronic health records fall short of early promises that they would reduce administrative costs, a recent study found. The cost of completing insurance- and billing-related activities in the EHR can represent more than a quarter of professional reimbursement for an emergency department visit.
Q: Is it necessary for organizations to provide HIPAA training for all workforce members, even those who are not involved in patient care? Does that include cafeteria staff, workers employed through a temp or staffing agency, etc.?
