UnitedHealth tightens reins on emergency department reimbursement

From Modern Healthcare:

The nation’s largest health insurer, UnitedHealth Group, is following rival Anthem’s footsteps with a new payment policy aimed at reducing its emergency department claims costs.

Under the policy, rolled out nationwide March 1, UnitedHealth is reviewing and adjusting facility claims for the most severe and costly ED visits for patients enrolled in the company’s commercial and Medicare Advantage plans.

Hospitals that submit facility claims for ED visits with Level 4 or Level 5 evaluation and management codes—codes used for patients with complex, resource-intensive conditions—could see their claims adjusted downward or denied, depending on a hospital’s contract with the insurer, if UnitedHealth determines the claim didn’t justify a high-level code.

Top 100 critical access hospitals for 2018

From Becker’s:

Here are the 2018 Top 100 Critical Access Hospitals in the U.S., including 19 first-time recipients, according to The National Rural Health Association’s Rural Health Policy Institute, iVantage Health Analytics and The Chartis Center for Rural Health.

The hospitals included in this list are top performers in managing risk, achieving higher quality, securing better outcomes, increasing patient satisfaction and operating at a lower cost than their peers.

ACUTE CARE is proud to be affiliated with several hospitals on the list:

Iowa

Avera Holy Family Hospital (Estherville)
Floyd Valley Hospital (Le Mars)

Minnesota

Sanford Luverne (Minn.) Medical Center

Nebraska

Memorial Health Care Systems (Seward)