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Observation or Inpatient: How to Avoid Medical Necessity Denials

Observation or Inpatient: How to Avoid Medical Necessity Denials image

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Medicare Part C auditors appear to be arbitrarily following the CMS two-midnight and criteria by InterQual and MCG Health when denying claims. But, when putting into practice the strategies from this essential webcast, your team can play an active role in combating the extremely high rate of denials that most likely are occurring in your hospital.

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Price: $229.00

Product Code: AR052418

Webcast Format*:

Description Biography

Learn from actual examples of outpatient and inpatient status cases!

Are you experiencing increased rates of medical necessity denials? You're not alone. 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, using their own discretion when following CMS rules to target claims. Welcome to the new era of Medicare Managed Care.

During this upcoming webcast, Dr. Brundage and Dr. Patel will review status assignment and difficulties with adherence to the two-midnight rule. 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.

Learning Objectives:

During this exclusive RACmonitor webcast, you will…

  • Gain a better understanding of the two-midnight rule relative to compliance;
  • Learn how effective documentation will reduce the risk of denial;
  • Discover targeting tactics used by auditors;
  • Learn how to communicate effective physician documentation to support medical necessity and,
  • Receive examples of observation and inpatient status cases.
Who Should Attend

UR nurses, case managers, physicians, hospitalists, physician advisors, inpatient coding and HIM professionals, hospital compliance and audit and appeal managers and directors, RAC coordinators, and clinical documentation improvement specialists.