Tracking denials data as a key performance indicator (KPI) can help identify gaps in provider documentation and create meaningful physician education. Learn how to leverage coding and CDI staff in tracking and managing denials data.
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.
Objective information produced by electronic data is fast becoming an essential component of value-based care and permeates every component of the healthcare ecosystem. Learn how to use electronic remittances as a source of truth for denials.
CMS has reinstated the short-stay reviews and high-weighted DRG reviews originally halted in 2019. The national contract to conduct these reviews was awarded to Livanta, one of the Beneficiary & Family-Centered Care and Quality Improvement Organizations.
Audits are ramping up across the country, creating additional headaches for many healthcare organizations as they simultaneously struggle with the delta variant of COVID-19.
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.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO, looks at the implications of a recent OIG brief on how Medicare Advantage organizations could use national provider identifiers (NPI) to monitor for fraud, waste, and abuse.
Laura Evans, CPC, and Julia Kyles, CPC, break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
