News

Q: Throughout the novel coronavirus (COVID-19) pandemic, case managers have faced many challenges when trying to find placements for patients who need to transfer from the hospital to a lower level of care, such as a skilled nursing facility (SNF). As we enter 2021, what challenges will persist and how can case managers work to overcome them?

UnitedHealthcare (UHC) is suspending certain prior authorization requirements for in-network hospitals and skilled nursing facilities through January 31.

President Donald Trump signed H.R. 7898 into law on January 5, amending the Health Information Technology for Economic and Clinical Health Act (HITECH Act) to require the Health and Human Services secretary to consider certain recognized security practices of covered entities (CE) and business associates (BA) when taking enforcement actions.

CMS recently released MLN Matters MM12126, which summarizes 2021 CPT and HCPCS Level II code updates for Part B outpatient therapy services. The changes permanently expand Medicare coverage of certain communication technology-based (CTB) services, including virtual check-ins and telephone assessments. 

Q: We're seeing a significant increase in pre-payment audit activity. How can we adapt our audit and denial management processes to cope with this shift?

Q: What are the benefits to having coders review charts for appropriate capture of CCs and MCCs, and how can our coding team get started in this process?

The Office of Inspector General (OIG) will be conducting a second round of audits to determine whether acute care hospitals are being inappropriately reimbursed for outpatient services provided to inpatients, according to a recent update to the OIG’s Work Plan.

Q: If we end a contract with a business associate (BA), does the BA need to provide us with assurance that all protected health information (PHI) has been destroyed? Is this something that should be written into the initial contract? What are the steps to take if the BA does not respond to requests to confirm deletion of PHI?

Q: The combination of hospitals' financial constraints and the isolation associated with remote work can create low morale within a case managment department. How should case management directors combat these factors?

GenRx Pharmacy, which is headquartered in Scottsdale, Arizona, reported a data security incident on December 18 affecting 137,110 individuals, according to the Office for Civil Rights (OCR) breach report.