The Government Accountability Office (GAO) says the Department of Health and Human Services (HHS) should take steps to reduce the number of Medicare appeals and strengthen oversight of the appeals process, according to a report released by the GAO...Read More »
Auditors target multiple conditions which for clinical validation denials (CVD). Personally, I found acute kidney injury (AKI) and malnutrition the most commonly defensible targets. On the other hand, I often agreed with auditors on their CVDs...Read More »
Clinical validation denials (CVD) result from a review by a clinician, such as a registered nurse, contractor medical director, or therapist, who concludes, retrospectively, that a patient was not really afflicted by a condition documented in...Read More »
Editor’s note: Over the coming weeks leading up to the conference, we’ll take some time to introduce members to a few of this year’s speakers. The conference takes place May 9-12, at the MGM Grand in Las Vegas, Nevada. For today’s Q&A, we caught up with ...Read More »
CMS and representatives of the private insurance industry have agreed to use a single set of healthcare quality measures, according to a statement published by CMS.Read More »
