Take a look at the appeal process from the perspective of a hospital that submitted a redetermination request after a claim for cataract surgery was reopened.
Most inpatient rehabilitation facility stays might not meet Medicare coverage or documentation requirements and compliance could be improved through a preauthorization process, according to a recent Office of Inspector General report.
CMS recently released updated guidance on billing intensity-modulated radiation therapy (IMRT) after an OIG audit found a 100% error rate in billing certain IMRT planning services.
The Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction proposed rule would make significant changes to the Conditions of Participation and could change the way hospitals work with competitive ambulatory surgery centers (ASC).
As hospitals transform from volume-based to value-based reimbursement, the role and functions of the utilization review (UR) committee are evolving. Learn how to refocus UR and use it as a tool for success now and in the future.
