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Each quarter, Auditor Monitor profiles a major healthcare auditing initiative, including prior authorizations, the Program for Evaluating Payment Patterns Electronic Report (PEPPER), telehealth, and the 340B Drug Program.

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Things I Wish I Learned When I Started in Utilization Review

Back-to-the-basics tutorial for utilization review of what Medicare provides and doesn't provide and how Medicare pays hospitals for services for both inpatient and outpatient.

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Examining the Advantages and Impacts of a Closed Observation Unit

Hospitals that do not place observation patients in a dedicated unit have great difficulty setting an expectation of a one midnight stay and a timely disposition. Moreover, providers are only compensated for a one midnight stay and can fail to reach a timely disposition on observation patients.

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Holding Feet to Fire: Making Payers, Auditors and Contractors Accountable

Learn a proven, ironclad method to defend your hospital's right to be paid for the necessary care you provide to your communities.

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