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These kinds of delays should be a focus of your utilization management team’s assessment of avoidable days.

CMS reported that these changes will result in taxpayer savings of nearly $750 million; however, the math seems a little unclear.

By comparing observed infant mortality rates post-ban with expected rates, based on historical trends, the researchers assessed the impact of these restrictive policies on neonatal and infant health outcomes.

Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered.

Social workers play a crucial role in ensuring that patients receive not only medical treatment, but also psychosocial support, and that our healthcare providers receive clarity regarding social barriers our patients face.

By analyzing data from 13 million births of Black and white women aged 10–44, researchers found that even in less vulnerable areas, Black women remained at higher risk of maternal mortality than white women residing in more vulnerable locations.

According to this guidance, sex is defined as an immutable biological characteristic, categorizing individuals strictly as male or female.

Just as multi-level connections to hospital operations became tied to documentation, the same happened with placement of clinician orders. 

The executive order’s broad and sweeping language has led to confusion among federal agencies, contractors, and communities as they work to interpret and implement the directive.

This concerning trend suggests that external influences such as diet, pollution, and reproductive choices may be key contributors to the spike in cases (NBC News, Advisory).

This policy change poses a fundamental challenge to the healthcare system: balancing federal enforcement with the moral and legal obligations to provide equitable care.

I have done my best to impart my medical knowledge and have shared my insights from my personal experience with COVID and my interaction with the medical establishment.

Justification of Inpatient hospitalization requires documentation in the History and Physical or post-operative note which thoroughly explains why the patient’s condition warrants closer monitoring or additional care.

On Dec. 5, the Centers for Medicare & Medicaid Services (CMS) provided additional guidance with the expectation that the Medicare Change of Status Notice (MCSN) that hospitals must start to provide this notice to qualifying individuals no later than Feb. 14, 2025.

This change emphasizes transparency and timely communication of decisions to enrollees, fostering better protection and equity.

One significant issue highlighted is the misrepresentation of care quality, which creates a false impression of superior performance by MA plans compared to traditional Medicare.

This distinction isn’t just about payment—it directly ties into quality reporting and metrics, such as hospital readmissions, which only involve patients classified as Inpatient.

These new CoPs reflect the CMS commitment to addressing the maternal health crisis through enhanced quality and safety standards for OB services.

This new rule will have a significant impact on protecting a subset of beneficiaries from coverage denials due to hospital reclassifications.

Don’t continue to pick up Q codes just because they have risk adjustment implications.

This practice and strict policy run the risk of hospitals defaulting to a conservative stance to place observation orders when there is any uncertainty about the patient’s status, because of the anticipation of a potential UHC denial.

CMS hosted virtual listening sessions to gather feedback from patients and caregivers involved in AHCAH. The responses were generally positive, with patients appreciating the convenience and personal nature of home-based care.

It would be optimal for everyone to have an advocate as they try to navigate the morass which is our healthcare system.

My philosophy is that a correct and complete set of discharge diagnoses can be used to reconstruct the entire patient encounter.