ED physicians commonly treat fractures. A fracture can be the result of a traumatic injury, such as a fall, or may be pathologic (i.e., due to a disease process). In general, fractures can be classified as open or closed, displaced or nondisplaced.
CMS recently announced a new category of payment programs: the Primary Cares Initiative. Within a few years, CMS expects 25% of primary care providers to join one of the five voluntary payment models.
Case managers typically provide support to adult patients in the hospital, focusing on their medical and social needs and easing their transition to the next level of care. But often, these patients aren’t the only ones who need support—they sometimes also have children or grandchildren who are struggling.
CMS recently released two quarterly updates effective July 1: Medicare Claims Processing Transmittal 4313, which is the July update to the OPPS, and Medicare Claims Processing Transmittal 4314, which is the related July update to the Integrated Outpatient Code Editor (I/OCE) Specifications, Attachment B.
Q: Our utilization review (UR) committee originally took a more strictly peer review role but over time its scope and responsibilities have broadened. We're not sure that it still makes sense for the UR committee to be categorized as a subcommittee of the medical staff. What is the current recommended reporting structure for a UR committee?
