Jessie, a nurse case manager, feels healthcare has changed since the beginning of the pandemic. She believes that the greatest change comes from the recent initiation of new healthcare coverage plans, primarily Medicaid managed care and Medicare Advantage.
In early June, Congress released a bipartisan draft bill called the American Data Privacy and Protection Act. The goal of this bill is to create a regulation that organizations in any industry would need to accord with compliance. On the surface, this sounds great, but in reality, it is unrealistic.
The variety of sources for commercial insurance requirements can present challenges to the utilization review (UR) specialist, as UR rules for every patient could differ depending on his or her insurance and that insurer’s policies. Apply these lessons to help UR manage commercial insurance requirements.
Many case managers use remote patient monitoring (RPM) to ease the pinch of staffing shortages and help to prevent readmissions. But some are warning that the accessibility of those services may be threatened by one of numerous changes in the 2023 Medicare Physician Fee Schedule proposed rule—a proposed 12% reimbursement reduction for RPM CPT® code 99454.
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
In August, the Office for Civil Rights (OCR) announced a settlement with New England Dermatology P.C., known as New England Dermatology and Laser Center, over the improper disposal of PHI, which is a potential HIPAA Privacy Rule violation.
