Articles Tagged With:
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Payers, Hospitals Disagree About Whether Patient Meets Inpatient Criteria
Payers are refusing to pay claims for gastric bypass, joint replacement, and even cataract extraction. Why? Because documentation in the record does not support the need for surgery.
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Tips to Improve Quality and Efficiency in Case Management Departments
One of the first steps to streamline case management operations is to reassign staff to new roles, such as focused discharge planning jobs and utilization review.
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Missing Clinical Documentation Reason for Many Claims Denials
More health plans are asking for certain pieces of clinical documentation before paying claims. If it is not there, the claim is denied. What are the specific issues arising?
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Team-Based Case Management Improves Care Coordination
A health system’s focus on revamping its care coordination led to a reduction in some 30-day readmissions, as well as other benefits.
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More Patients Newly Eligible for Medicaid; Many Unaware
Medicaid has expanded in many states so previously uninsured patients can access coverage. However, many may not be aware they qualify. Learn how one health system helps eligible patients enroll.
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Patient Access Leaders Tell Important Stories at Conferences
Hospital leaders may view patient access leaders as operating mostly “behind the scenes.” Presenting at conferences is a great way to change that outdated perception.
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Growing Role for Patient Access: Payer Contract Negotiations
Including patient access in the process is part of acknowledging the ever-expanding importance of front end participation in the revenue cycle.
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Vaping-Related Lung Injury Cases in EDs Decline, Fresh Concerns Emerge
Investigators now have more definitive data about both the trajectory of the outbreak and its potential causes.
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Can Telemedicine Deliver High-Quality Geriatric Care to Rural EDs?
Under a three-year research project, a New Hampshire medical center will be providing geriatric support and expertise to four rural hospitals through a mature telemedicine program already in place. One aim of the program is to enable senior patients in rural areas to receive high-quality geriatric care in their local EDs rather than face transfer to larger hospitals that may be far away.
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Accountability Program Helps Identify Opiate Prescribing Outliers, Addresses Education and Quality Needs
It stands to reason that fully understanding when and why providers under- or overprescribe opiate medications might assist in standardizing prescribing practices and also help bring the opioid epidemic to heel. However, most healthcare systems lack the tools to easily collect this information meaningfully.