Recent announcements from payers raise concerns that claims for observation services could be the next “fertile field” for reviews, audits, and denials. These announcements, coupled with announcements from the Centers for Medicare & Medicaid Services (CMS) regarding the return of Recovery Audit Contractor (RAC) audits, means that observation may no longer be the “safe haven” it has traditionally been. Since payers have, historically, subjected observation claims to little scrutiny, many providers may not be prepared for the coming onslaught of audits.
To prepare for denials and audits, providers must understand the contractual conditions imposed on observation claims. Utilization reviewers and case managers must recognize the exquisite time-sensitivity of observation in order to optimize resources and ensure that reviews occur in relevant time frames.
Similarly, denials management teams must be ready to assess appealability of observation denials. Revenue cycle managers must work with clinical documentation specialists and health information management (HIM) to ensure timely feedback— human and electronic— to clinicians to match the services delivered with the services ordered.
With such thin margins, and such large hospital populations of observation patients, the potential for significant numbers of observation denials could result in financial ruin for many hospitals. That’s why you and your team cannot miss this opportunity to prepare for potential observation denials and audits with Dr. John K. Hall, during this exclusive RACmonitor webcast.
Why This is Relevant:
Few hospitals are prepared to fully assess observation claims or manage denials. Denials of observation claims will be financially devastating for most hospitals.
During this RACmonitor webcast, led by Dr. John Hall, you will…
- Learn how to distinguish inpatients from outpatients with observation services;
- Understand time sensitivity of observation services;
- Learn the steps in preparation for observation audits;
- Understand preparation for observation denials; and
- Recognize economic impact of observation denials.
Who Should Attend:
Those individuals who will gain the most from this webcast led by Dr. Hall include UM staff, physician advisors, case managers, revenue cycle managers, and appeals managers.