The TopTen WINNING UR Program Services for 2025 – Part 2
Does YOUR UR Program have all TEN services?What are your UR Program’s Focus Areas? Do you know acceptable vs. unacceptable documentation?Which “Mode” are you in? Denial Mgmt or Denial Avoidance? The TopTen WINNING UR Program Services for 2025 – Part 2 We continue our Discussion of “Standard” and “Optional” Equipment needed Be sure…
The TopTen WINNING UR Program Services for 2025
Does YOUR UR Program have all TEN services?What are your UR Program’s Focus Areas? Do you know acceptable vs. unacceptable documentation?Which “Mode” are you in? Denial Mgmt or Denial Avoidance? The TopTen WINNING UR Program Services for 2025 Discussion of “Standard” and “Optional” Equipment needed Be sure to register to get emails about all…
Acceptable Case Manager Documentation Practices
Do you know how to detect “radioactive” documentation?Do you know the critical practices of Clinical Case Management? Do you know acceptable vs. unacceptable documentation?Do you have clarity on how “standing orders” impact documentation and claims? Acceptable Case Manager Documentation Practices From Radioactive to Reimbursable: A Case Manager’s Guides to Documentation Case Discussions on Relevant…
AMI Patient Leaves AMA: What can you bill and how?
Tests for AMI, give Aspirin, monitor 90 mins, then he leaves…NOW what? And what Status can you bill and get paid?What will the Payer Auditor look for? And what if the same patient came back later? AMI Patient Leaves AMA: What can you bill and how? Case Discussions on Relevant Processes & Disease…
Effect of Chevron Verdict on UR/Physician Advisors
Do you know Chevron deference was all about before now? Do you know HHS Regulations might now be challenged? Do you know how such challenges may affect reimbursements? Do you know what steps you might take NOW? Effect of Chevron Verdict on UR/Physician Advisors The recent decision by the Supreme Court now allows Federal…
Navigating Medical Necessity for Inpatient as True North – Part 2
Do you know how documentation denotes only Mild Cellulitis?Do you know how it denotes Moderate or Severe?Do you know how it denotes Critical or Life-Threatening?Do you know what to do if you get frivolous denials for Cellulitis? Navigating Medical Necessity for Inpatient as True North – Part 2 WHERE does the needle point, given…
Navigating Medical Necessity for Inpatient
Do you know how documentation denotes only Mild CHF?Do you know how it denotes Moderate or Severe?Do you know how it denotes Critical or Life-Threatening?Do you know what to do if you get frivolous denials for CHF? Navigating Medical Necessity for Inpatient as True North WHERE does the needle point, given what’s in the…
Review of CMS’ Secret FAQs for MA Plans
Do you know if they can make up their own criteria??Do you know how to get their internal criteria?Do you know what to do if they ignore the 2MN rule?Do you know what to do to report problems with their denials decisions? Review of CMS’ Secret FAQs for MA Plans Discussion of a Few…
All Aboard the Two-Midnight Train to Inpatient
Do you know the Keys to Understanding the Two-Midnight Rule??Do you know what’s necessary to reach the Two-Midnight Benchmark?Do you know when the Two-Midnight Presumption is acceptable?Do you have guardrails in place to cover documentation for the Benchmark? All Aboard the Two-Midnight Train to Inpatient Discussion of The Two-Midnight Rule forMedicare & Medicare Advantage…
What’s in YOUR UR Program?
Do you have Physician Advisor & UR Gap Coverage?Do you have Comprehensive Dx Specific OnDemand & Live Education?Do you have Front-to-Back Analytics Service?Do you have a Denial Avoidance & Management Portal? What’s in YOUR UR Program? Discussion of the Critical Focus Areasfor any UR Program today… Case Discussions on Relevant Processes & Disease Specific…
The TopTen WINNING UR Services in 2023
Does YOUR UR Program have all TEN services? What are your UR Program’s Focus Areas?Which “Mode” are you in? Denial Mgmt or Denial Avoidance? The TopTen WINNING UR Program Services in 2023 Discussion of “Standard” and “Optional” Equipmentneeded to Succeed – now more than ever Case Discussions on Relevant Processes & Disease Specific Topics BY…
Condition Code 44 Revisited in 2022
Do you know the key requirements to use Code 44? Do you know what’s CHANGED recently? Do you know how to proactively identify the need to use Code 44? Do you know how a Physician Advisor can offer key support for its use? Condition Code 44 Revisited in 2022: Case Studies & A Decision Tree…
1,005 Reasons to Appeal 100% of Your Denials (and how to affordably do that)
Do you know DANGERS of NOT Appealing all those Denials? Do you know the top 5 reasons you must appeal ALL denials? Do you know the SIXTH reason you should appeal them all? Do you know why, how and when you can affordably appeal ALL denials? 1,005 Reasons to Appeal100% of Your Denials How can…
EPAS: To Be or Not to Be… and you do NOT need a Whistle!
Do you know what to do if you stumble onto a Compliance issue? Do you know why, how and when to do the right thing?Do you know why, how and when to protect yourself while doing that?Do you know why, how and when you might need some legal representation? To Be or Not to Be……
EPAS: More on the Use of Revenue Cycle Automation
Do you know what role Automation can play in the Revenue Cycle? Do you know what you can do with HL7 & FHIR in the Revenue Cycle? Do you know what role Automation can play to help with Denials and Appeals? Do you know how your Hospital can use the same automation Payers now use?…
EPAS: The Transformation of Physician Advisor Services
Do you know what role Automation can play in the Revenue Cycle? Do you know if the claims of “Complete Revenue Cycle Automation” are real? Do you know how your Hospital can use the same automation that the Payers now use? The Transformation of Physician Advisor Services? Is it possible to replace the Physician…
EPAS: Behavioral Health Care & Medical Necessity
Do you know the Medical Necessity Guidelines for Behavioral Health? Do you know the 13 Requirements for Psychiatric Acute Inpatient Criteria? Do you know the 10 Continuing Requirements for Continued Authorization Requests? Behavioral Health Care & Medical Necessity Terms, Requisites, and Templates for Usein Psychiatric Acute Inpatient Criteria Be sure to register to…
EPAS: Condition Code 44 Revisited
Do you know the key requirements to use Code 44?Do you know how to proactively identify the need to use Code 44?Do you know how a Physician Advisor can offer key support for its use? SEE A NEW DECISION SUPPORT TREE FOR CONDITION CODE 44 Condition Code 44 Revisited: Case Studies & A Decision Tree…
EPAS: COVID Effects on Denials, Physician Advisors and KPIs
Do you know which KPIs are being affected?Do you know how much the KPIs are being affected and WHY?Do you know how to validate the increasing value of a Physician Advisor? SEE A SPECIAL DEMONSTRATION OF A NEW COVID-19 PREDICTION TOOL Using a COVID-19 plug-in model, examines the best fit parameters to predict the future…
EPAS: Lessons Learned from Ridiculous Denials for COVID-19
Do you know how to find all the links to the updated waivers? Do you know your State’s regulations on UR Teams, licensing, etc.? Do you know what to do if the Payer says they didn’t get what you sent? Lessons Learned from Ridiculous Denials for COVID-19 Discussion of What’s Happening & How to…