AppriseMD

The American Hospital Association commended CMS for initiating steps to expand oversight of the 2026 Medicare Advantage (MA) plans last month. You can read more on their statement at https://lnkd.in/djEFmRXF

AppriseMD overturns a Medicare Advantage denial where the patient left the hospital against medical advice after spending only one night in the hospital. Read the full case study at https://lnkd.in/ecrduSZn

Aggressively addressing denials is essential for maximizing reimbursement. The ideal solution involves a comprehensive approach that focuses on getting admission decisions correct upfront and effectively managing post-denial challenges. Read more in our paper, "Addressing Healthcare Reimbursement," that focuses on denial management and medical necessity at https://lnkd.in/ehJkfQfi #denialmanagement #medicalnecessity #utilizationreview #healthcare #reimbursement

AppriseMD is hiring case preparation physicians to review medical records for utilization review while assisting AppriseMD physician advisors. To learn more or apply, visit apprisemd.com/careers.

AppriseMD expresses our deepest sympathies to the family of UnitedHealthcare CEO Brian Thompson and the entire UnitedHealth Group organization. 

Can a hospital admission for a one-day, short-stay, where the patient leaves the hospital against medical advice, be inpatient? Yes. AppriseMD’s new case study shows that the likelihood of ongoing treatment needed for sepsis due to a urinary tract infection, and a mild heart attack, was reason enough to approve an inpatient level of care despite a one-night stay. #UtilizationReview #DenialManagement #hospitals #RevenueCycle #CaseStudy https://lnkd.in/ecrduSZn

California Governor Gavin Newsom recently signed 17 bills addressing the deployment and regulation of generative AI technology, including legislation that will "require health insurers to ensure that physicians supervise the use of AI tools that make decisions about services and insurance claims," according to a recent article published in Becker's Healthcare (https://lnkd.in/dSuUA--P). Read more about the use of AI in claim denials in AppriseMD's white paper, "The Use of AI in Claim Denials" https://lnkd.in/ev-9ayMx.

Early 2024 data published by AppriseMD in its paper “Medicare Advantage and the Two-Midnight Rule: 2024 Findings” suggested that Medicare Advantage Organizations posed a significant challenge to a hospital's ability to collect reimbursement for medical services provided. These findings are consistent with Becker's findings shared in a recent article which states "hospitals find themselves caught in a taxing and costly battle to provide high-quality care while navigating excessive administrative hurdles" built by the payers. Read more MAOs and the Two-Midnight Rule at https://lnkd.in/ep64EwKR

Is your utilization management team aware of, and addressing, the invisible barriers to revenue reimbursement such as silent or self denials? Read more about these hidden obstacles that you may not be tracking in our new paper "Addressing Healthcare Reimbursement: A Focus on Denial Management and Medical Necessity," at https://lnkd.in/ehJkfQfi

Healthcare organizations can no longer afford to take a hit on reimbursement, therefore medical necessity determinations and denial management must become a priority. In our latest paper, AppriseMD looks at how hospitals can tackle barriers to reimbursement, increase the focus on medical necessity and uncover hidden factors that contribute to revenue loss. Download, "Addressing Healthcare Reimbursement: A Focus on Denial Management and Medical Necessity," https://lnkd.in/ehJkfQfi #reimbursement #utilizationreview #utilizationmanagement #medicalnecessity #denialmanagement #healthcare