Apprise MD

12/25/2025

Warmest wishes for a safe and happy holiday season from the team at AppriseMD.

12/23/2025

Read all our 2025 case studies at apprisemd.com/case-studies/

12/18/2025

Providers need to scrutinize automated denials from payers to ensure appropriateness. Read more here https://apprisemd.com/use-of-ai-in-claims-denials/

The Use of AI in Claims Denials A Compendium of Artificial Intelligence Use in Utilization Review Payers deny claims at a rate that climbs higher each year. However, the increasing use of artificial intelligence (AI) to automatically deny claims without review creates a new issue for hospitals and r...

12/16/2025

AppriseMD physician advisors recommended inpatient level of care during a second-level physician review that was later denied by the Medicare Advantage plan. AppriseMD advocated for the inpatient admission during the peer-to-peer payer review and was able to overturn the denial and unlink the hospitalization with the previous admission to secure reimbursement for the hospital. https://apprisemd.com/case-study-unlinking-readmission-p2p/

An AppriseMD physician advisor successfully defended a secondary review recommendation for an inpatient LOC admission, resulting in the denial being overturned.

12/11/2025

According to Becker's Healthcare, "UnitedHealth Group is projecting its Medicare Advantage enrollment will decrease by 1 million people in 2026."

While the MA market share grew this year, it was not as much as anticipated. The lower than projected enrollment growth stems from several factors, one of which includes provider pushbacks. This is not surprising given the prevalence of claim denials, prior authorization requirements and reimbursement challenges that have plagued hospitals and physicians.

12/09/2025

AppriseMD was able to overturn a denial and get a patient’s hospitalization unlinked from the prior admission during a peer-to-peer payer review. Read more at https://apprisemd.com/case-study-unlinking-readmission-p2p/

12/03/2025

AppriseMD joins the World Health Organization in observing the International Day of Persons with Disabilities. Roughly 15% of the world's population lives each day with a disability but also with courage and determination. As a healthcare organization, we strive to raise awareness of all those facing disabilities on this day and every day.

12/02/2025

Slow reimbursement from payers was one of the most cited reasons for more than 30 health systems dropping or not renewing Medicare Advantage (MA) contracts for some MA plans.

Learn more at https://www.beckershospitalreview.com/finance/20-health-systems-dropping-medicare-advantage-plans-2025/

11/27/2025

AppriseMD is thankful for its hospital and health system partners as well as its outstanding team of physician advisors, case preparation physicians and physician support team.

Happy Thanksgiving from AppriseMD!

11/25/2025

Several healthcare insurance companies were penalized for improper claim denials, slow reimbursements, and mental health parity violations this year, according to a recent report by Becker's Healthcare. Learn how AppriseMD addresses improper claim denials with their peer-to-peer payer review and written appeal services. https://apprisemd.com/

11/20/2025

228 healthcare providers cite revenue cycle management as their highest investment priority, highlighting the value of physician advisors in maximizing a hospital’s reimbursement.
https://www.bain.com/insights/healthcare-it-investment-ai-moves-from-pilot-to-production/"

Revenue cycle management and clinical workflow return as providers' key priorities while payers emphasize utilization and network management.

11/18/2025

A patient experiencing painful swelling and an abscess spent three days in the hospital for diagnosed cellulitis that required IV antibiotics and pain medication. The hospital admission was denied by the Medicaid Managed Care plan but reversed after an AppriseMD physician advisor completed a peer-to-peer payer review with the Managed Medicaid plan medical director. The criteria for inpatient hospital care due to cellulitis are quite strict; however, the experienced AppriseMD physician advisor reasoned that the denial should be rescinded based on the high intensity of pain management, leading to the payer medical director approving the higher level of care.

Read the full case study at

Short stay case study from AppriseMD involving a patient with Lennox-Gastaut syndrome highlights the need for a peer-to-peer, resulting in denial overturned.