It may seem logical, but clinical judgement—or mistakes thereof—represents a serious concern in relation to malpractice suits according to a CRICO Strategies study, MedPage Today reported. Diagnosis-related malpractice cases cost nearly $2 billion, in commercial liability payouts....Read More »
More than $3 million could be owed by Anthem, according to an Office of Inspector General (OIG) audit. Anthem reportedly submitted unsupported diagnosis codes for “123 of the 203 enrollee-years,” for seven high-risk groups....Read More »
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Recently, we’ve seen an uptick in clinical validation denials regarding acute pulmonary insufficiency and acute respiratory failure following surgery. What can we do to fight or prevent denials for these diagnoses?Read More »
The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and...Read More »
Are institutions appealing sepsis denials if the patient meets sepsis-2/super systemic inflammatory response syndrome (SIRS) criteria, but not sequential organ failure assessment (SOFA) criteria? We have one hospital in our system that uses only sepsis-2 as their criteria, and many of them have...Read More »
