Remove Admissions Remove Documentation Remove Hospital
article thumbnail

Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. These changes will impact how hospitals approach their contracts and denial strategies.

Hospital 130
article thumbnail

Navigating the Complexities of Social Admissions in Healthcare

EvidenceCare

Social Admission vs. Medical Necessity In healthcare, the term “social admission” signifies instances where patients find themselves admitted to a hospital primarily for non-medical reasons. However, these admissions come with their own set of difficulties, particularly in the realm of Medicare coverage and reimbursement.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

This comprehensive guide provides hospital and revenue cycle leadership with vital insights on preparing for CERT audits and establishing processes for compliant documentation. There can also be state variations with additional regulations regarding documentation and coding requirements that layer on top of federal guidelines.

article thumbnail

Understanding DRG Codes and Their Impact on Hospitals

EvidenceCare

In our efforts to empower hospital clinicians to provide better care by having real-time transparency to cost and benchmark utilization data, we’ve learned that one of the core code systems that defines modern hospital resource management – Diagnosis-Related Groups (DRG) – is misunderstood or even unknown. What is a DRG?

Hospital 130
article thumbnail

New Insights on Medicare Advantage Plans and The Two-Midnight Rule

EvidenceCare

In case you aren’t familiar, the Two-Midnight Rule mandates that a patient’s hospital stay must span at least two midnights to qualify for inpatient status, directly influencing reimbursement rates and compliance requirements. Compliant documentation has also become more challenging. Another issue is “inpatient only” procedures.

article thumbnail

Friday Reflection 38: Yesterday’s Solutions; Today’s Problems

Sensible Medicine

Most of my undergraduate medical education took place at New York Hospital, where a medical error occasioned the first calls for duty hour reform. I was responsible for staying at the bedside of (or at least in the hospital with) my patients until they were stable. PR was admitted to my service at a hospital where I briefly attended.

article thumbnail

Understanding GMLOS and ALOS

EvidenceCare

These measures play a fundamental role in hospital management, financial planning, and patient care optimization. By understanding and leveraging GMLOS and ALOS, hospital executives can improve operational efficiency and patient outcomes. It is the simplest and most commonly used metric for evaluating patient stays.