If you are experiencing increased rates of medical necessity denials, you're not alone. And most likely you and your team are justifiably frustrated by the arbitrary approach taken by auditors who pick and choose the criteria that best fits their goal to deny claims and avoid reimbursement payments. With so many hospitals struggling with medical necessity denials, the issue has risen to epidemic proportions. That's because there is a disconnect between the status guidelines physicians are following and the tactics used by Medicare Part C auditors who use their own discretion when following CMS rules to target claims.
During this exclusive RACmonitor webcast, Dr. Patel reviews a straightforward breakdown of status assignment, including differentiating between the rules that affect Medicare versus non-Medicare patients. His presentation highlights the nuances of the two-midnight rule as well as how to risk-stratify your patients into the appropriate status. Dr. Patel reviews status assignment and difficulties with adherence to the two-midnight rule, along with an in-depth and detailed look at several real-world status cases. You and your team will learn that when providers assign the appropriate status to support medical necessity, they optimize quality data and ensure appropriate hospital reimbursement. You will also be exposed to the Brundage approach to physician education—understood to be the only one of its kind in the industry.
Why This is Relevant:
Too often, insurance companies and auditors pick and choose how they want to apply the two-midnight rule, usually to their own benefit. This RACmonitor webcast focuses on the correct approach to status review in order to decrease the likelihood of denials. However, if a denial is inevitable, medical necessity documentation can strengthen the language in the electronic medical record (EMR) to support a successful peer-to-peer review, leading to an appeal if necessary.
During this RACmonitor webcast, you will…
- Learn how to differentiate between two rules: Medicare and the two-midnight rule; and the commercial payers' severity of illness (SOI) and intensity of service (IOS); rules;
- Understand how the two-midnight rule affects patient status;
- Learn the importance of severity of illness (SOI) and risk stratification in non-Medicare patients;
- Understand the need for physician documentation to support medical necessity; and
- Learn from a review of actual cases the difference between inpatient and observation status.