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Use Patient Status to Stop Claim Denials

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Learn how to combat denials as a result of auditors who arbitrarily select the CMS two-midnight rule and criteria by InterQual and MCG Health that best fits their goals in order to deny claims submitted by your facility.

Price: $229.00

Product Code: AR091919

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Description Biography

For too long and too often, commercial payers have been denying claims by leveraging Medicare criteria to their own advantage in order to avoid reimbursement for services provided by hospitals and health systems. Now there is a proven strategy to level the playing field —to turn the tables and protect your revenue from recoupment. During this exclusive RACmonitor webcast, Dr. Patel will review a straightforward breakdown of status assignment, including differentiating between the rules that affect Medicare versus non-Medicare as well as risk stratifying your patients into the appropriate status. Dr. Patel will also provide an in-depth and detailed analysis of several real-world status cases, including "gray-area" cases, pediatric cases, plus a further discussion of Interqual/MCG requirements. You and your team will learn that when the correct status is assigned to support medical necessity, it will optimize quality data and ensure appropriate hospital reimbursement.

Why This is Relevant:

Insurance companies and auditors pick and choose how they want to apply the two-midnight rule, usually to their own benefit. This exclusive 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.

Learning Objectives:

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.

Who Should Attend:

Healthcare professionals who will benefit most from this RACmonitor exclusive webcast, led by Dr. Hiten Patel, include physician advisors, hospitalists, physicians, case managers, utilization review committee members, social workers, and hospital administrators.