As inpatient medical necessity denials continue to rise, it is important to evaluate possible drivers of change in the patient presentation and clinical encounter resulting
1. Trends Seen in the Increase of Downgrades for Emergency Department Level Visits Many payers are developing proprietary algorithms for determining their own Emergency Department
Medical coders must familiarize themselves with several new codes for Caregiver Training Services, which became effective January 1, 2024. These new services are intended to improve patient
A collection of case studies involving clinical appeals challenges and revenue cycle solutions Managed Resources partners with healthcare systems, hospitals and payers across the United
How to Review & Determine the Most Difficult Cases Our client, a large four-hospital system, was facing a difficult challenge: THE CLIENT EXPERIENCED A SIGNIFICANT
Emergency Department Evaluation & Management (E&M) Level Codes: How a Clinical Charge Audit Can Evaluate Billing Practices & Documentation Our client, a large hospital sysem,