I have seen a question pop up lately in a few forums asking when it is appropriate to provide a patient that is leaving an acute care...

Paul Arias EJD, MIS, BSN, RN, CMAC Alexander v Azar was finally decided after many years spent in the court system. Plaintiffs in a class...

Ensursing you have the law behind you when you want to discharge a difficult patient can be tricky. Hospitals and Healthsystems struggle...

Want to learn how to provide care for Medicare and Medicaid patients without running afoul of the government's CMP? Read this article on...

Denial prevention is the ability to use a systematic approach to review admission to meet the definition of medical necessity. It...

To effectively position a healthcare facility for successful outcomes in reducing readmissions and either avoiding a penalty from CMS or...

I am often asked what data should be tracked to show outcomes for case management and my response always starts with what outcomes do you...

The federal government established ERISA in an effort to protect citizens’ interest in their pension plans. The law was enacted in 1974...

What Is Utilization Review (UR)? UR is the process by which medical necessity is established using a systematic approach based on a set...

For years hospitals have been held liable for a loss of payment due to a lack of medical necessity that demonstrated why a patient needed...

https://www.cms.gov/files/document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf A few...

As defined by the Centers for Medicaid and Medicare (CMS) discharge planning is “A process used to decide what a patient needs for a...

Hospital Case Management has been in existence for over 30 years. In that time many changes have occurred that have influenced the case...

Introduction Case Management and Utilization Review departments face an uncertain future with respect to the transformation of...