1.
Healthc Financ Manage
; 69(2): 74-9, 2015 Feb.
Artigo
em Inglês
| MEDLINE
| ID: mdl-26665543
RESUMO
Payment denials based on questions of medical necessity have increased significantly for many hospitals, while the odds of mounting a successful appeal have diminished. Instead of focusing primarily on making appeals more effective, hospitals should construct a strategy for reducing the incidence of medical-necessity denials through the collection and analysis of denials data. Hospitals can break down the data to produce optimal approaches at both the case management and service levels to minimizing lost revenue from medical-necessity denials.
Assuntos
Economia Hospitalar , Eficiência Organizacional/economia , Hospitalização/economia , Formulário de Reclamação de Seguro/normas , Reembolso de Seguro de Saúde , Administração de Caso , Coleta de Dados , Custos Hospitalares
2.
Physician Exec
; 37(3): 50-4, 2011.
Artigo
em Inglês
| MEDLINE
| ID: mdl-21675315
3.
Healthc Financ Manage
; 63(8): 62-7, 2009 Aug.
Artigo
em Inglês
| MEDLINE
| ID: mdl-19658326
RESUMO
Hospitals should take a strategic approach to denials management. Some key areas to monitor are: Prior authorization/notification. Concurrent review. The appeals process.