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Be Knowledgeable About Hospital’s Payer Contracts
To prevent denials, case managers must know the requirements of each individual payer. But at some hospitals, the finance and/or managed care departments don’t provide case management with the utilization review section of the contract where the rules are outlined.
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How to Avoid Four Types of Denials
Case managers must take a proactive approach to reducing the denial rate — and the best way to do it is to prevent the denial.
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Types of Case Manager Reviews
This chart shows the types of payer reviews case managers typically perform.
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When Managing Denials, the Best Defense Is a Good Offense
Denials represent a significant amount of lost revenue. Case managers should take an active role in preventing and managing denials.
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How Many Conduction Defects?
The ECG and long lead II rhythm strip in the figure with the article was obtained from a 58-year-old man who was admitted to the hospital with chest pain and weakness. How would you interpret the tracing? How many different types of conduction disturbances can you identify?
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Clinical Briefs
In this section: using diuretics in heart failure patients; sexual dysfunction in patients with diabetes; and treating subtle gastrointestinal symptoms.
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Buprenorphine Extended-release Injection (Sublocade)
Buprenorphine extended-release injection is indicated for the treatment of moderate-to-severe opioid use disorder in patients who have initiated treatment with a transmucosal buprenorphine-containing product, followed by dose adjustment for a minimum of seven days.
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Travelers Unaware of the Need for Pre-travel Vaccinations
Outbreaks of measles continue to occur in the United States, mostly because of imported cases. More than half of these occur as the result of inadequately vaccinated returning U.S. travelers who acquire measles infection abroad.
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Newer Guidelines for Influenza Testing This Season
The California Department of Public Health and the CDC have recommended that, regardless of the results of prior rapid influenza testing, empiric therapy with a neuraminidase inhibitor should be administered promptly to patients hospitalized with influenza-like illness or suspected influenza.
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L-methylfolate for Bipolar Disorder
L-methylfolate improves some symptoms in major depression in people with type 1 bipolar disorder.