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Health eSource July 2019

Vol. 15 No. 11  

Featured Articles


Registered Nurses May be Classified as Exempt. Are Utilization Review Nurses Exempt as Well?

Utilization Review (UR) Nurses review hospital patient medical records for medical necessity, level of care, and length of stay to assist in determining reimbursement and preparation of clinical and authorization appeals where necessary. The courts that have analyzed whether this job is exempt from the overtime requirements of the Fair Labor Standards Act (FLSA) have generally found that the UR nurses do not meet the definitions required for an exemption. The rationale, up until recently, has rested on the UR job descriptions that included minimum qualifications of a licensed practice nurse (LPN) or registered nurse (RN) license and three or so years’ experience.


CMS Revises Guidance Regarding the Use of Statistical Sampling for Overpayment Estimation

On September 28, 2018, the Centers for Medicare & Medicaid Services (CMS) announced updates to its sub-regulatory guidance related to Medicare contractors’ use of statistical sampling for estimating overpayments. The updates, effective January 2, 2019, were announced via Change Request 10067, Transmittal 828, and served to revise the Medicare Program Integrity Manual (MPIM) (CMS Internet-Only Manual 100-08) Chapter 8, Section 8.4.

Agriculture & Food

States Are Looking to Pharmacists to Increase Access to Tobacco Cessation Therapy

Though the United States’ adult cigarette-smoking rate is at an all-time low, the health effects of smoking remain prevalent and devastating. Helping current smokers quit should remain a focus for healthcare professionals and policy makers. Some states are recognizing the capabilities and accessibility of pharmacists and are looking to them to help by authorizing pharmacists to autonomously prescribe tobacco cessation therapy.