Hospital Management
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Support Medical Necessity or Face Denials for Stat Diagnostic Tests
Claims are sometimes deemed uncollectible after the first attempt to appeal a denial is unsuccessful. This article discusses approaches to help ensure payment.
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Payer Says Service Is Non-covered? Patient Access Put in Difficult Position
Patient access faces difficult conversations with patients if services are non-covered. This article discusses steps to help stop lost revenue.
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Did Patient’s Insurance Change? Auths, In-network Status May Change Too
Patients often fail to tell patient access if their coverage changes, and eligibility verification software responses do not always catch it. This article discusses steps that can help prevent claims denials.
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Provide Indisputable Proof: Patient Meets Criteria for Level of Care
Increasingly, payers are disputing the patient’s level of care, resulting in denied claims. This article discusses ways to help prevent lost revenue.
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Make ‘Peer-to-Peer’ Happen Within 24 Hours, Or Face Denied Claim
Payers are requiring time frames as short as 24 hours for peer-to-peers between the patient’s and payer’s physicians, or they’ll deny the claim. This article discusses several strategies that can make this conversation happen quickly enough to avoid denials.
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Coding Is Must-have Skill for Patient Access: Fix Errors Before Denial Comes
Coding has become an essential skill for patient access, in light of the surge in claims denials occurring due to the switch to ICD-10. This article will discuss steps patient access can take to ensure correct coding.
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Purdue IRB Shuts Down Youth Study
An IRB at Purdue University in West Lafayette, IN, has terminated a study of young people with high blood pressure after a youth camp last summer was plagued by multiple incidents of violence and sexual harassment.
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OHRP and FDA Issue Guidance on IRB Meeting Minutes
The Office for Human Research Protections and the FDA prepared guidance to inform IRBs about how best to prepare and maintain IRB meeting minutes under both agencies’ regulatory requirements.
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Counterpoint: Transplant Recipients of Research Organs Entitled to Informed Consent
Interventional research to preserve the viability of donor organs means the transplant recipient is a research subject entitled to give informed consent — period, experts say.
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Sample of Two-page Informed Consent Document
The University of Cincinnati developed a two-page informed consent form that could be used in an emergency research study, involving the administration of pain medication to people who were in acute traumatic pain.