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By analyzing claims data to assure that the hospital was reimbursed appropriately and aggressively appealing all denials and underpayments of claims, DCH Health System in Tuscaloosa, AL, was able to generate a 1.25% increase in net patient revenue.
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Hospitals are losing large amounts of money on extra and inappropriate diagnostic testing and procedures, as well as outpatient procedures performed in the inpatient setting because third-party payers frequently are denying the claims, says Brenda Keeling, RN, CPHQ, CPUR, of Patient Response, a Milburn, OK, health care consulting firm.
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Hospital reimbursement is being squeezed from all sides. In the proposed Inpatient Prospective Payment System rule for fiscal year 2010, the Centers for Medicare & Medicaid Services (CMS) has proposed slashing the Medicare reimbursement update to account for improvements in documentation and coding and limiting reimbursement for readmissions.
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A new plan for admitting patients from the ED at Johns Hopkins Bayview Medical Center in Baltimore jointly developed by an ED physician and a hospitalist, decreased ED throughput for admitted patients 98 minutes (from 458 minutes to 360 minutes) from the same period a year earlier, despite an 8.8% increase in the ED census.
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It took Nancy Sikorski, RN, BA, nearly four months of research, telephone calls, and e-mails to bring together some of the RN clinical documentation improvement specialists in northern Illinois for a meeting.
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When the RN clinical documentation improvement specialists at Central DuPage Hospital set up a networking meeting with their peers from other hospitals in northern Illinois, they never dreamed that their efforts would lead to the formation of a new organization with regular meetings.
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Researchers who reviewed thousands of studies have found that enhanced hospital discharge support might prevent or delay hospital readmissions for heart failure and stroke patients.
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Case managers are under pressure to discharge patients as quickly as possible from the acute care hospital, but they may have liability for negligent, premature discharge, according to Elizabeth Hogue, Esq., a Washington-DC based attorney specializing in health care issues.
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During the Recovery Audit Contractor (RAC) demonstration project, the auditors were extremely focused on the level-of-care orders to the point of denying admissions that did not have a clear admission order such as "admit to inpatient."
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The more your hospital does up front to prepare for Medicare's Recovery Audit Contractor (RAC) program, the more money it will save in the long run, experts say.