Establishing Medical Necessity to Ensure Correct Patient Status and Payments

Health insurers employ a number of measures to deny payments or reduce reimbursement amounts. They’ll frequently argue that a patient should have been treated in a lower-intensity setting or at a lower admitted status…or not at all. One common insurer tactic is pushing a patient into observation status, which not only involves a reduced payout vs. inpatient status, but it hinders a hospital’s ability to transfer the patient. Once they succeed in downgrading a patient’s status, insurers turn their attention to medical necessity, or lack thereof, to deny claims.

How do you fight back? By strengthening your clinical documentation, infusing it with irrefutable evidence that each patient has received an appropriate level of medical care in the most suitable setting. During this exclusive RACmonitor webcast, Dr. Andrew Markiewitz will use sample charts to illustrate common deficiencies and then explain how you can increase the value of information in your documentation — fortifying defenses against payer ploys to deny you of revenue that’s rightfully yours.

Why This Is Relevant:

Let’s face it, you’re at a disadvantage when confronting health insurers. They’ll go to great lengths — sometimes even hiring physicians — to uncover weaknesses in your clinical documentation and then try to limit or deny payment. But, given today’s severe financial challenges, you can’t afford to wave the white flag. You don’t have to. Attend this RACmonitor webcast for guidance with ensuring that your clinical documentation can withstand aggressive payer tactics.

Learning Objectives:

• Understand current trends of health insurers trying to limit reimbursements and deny payments
• Learn how to refine your documentation according to the principle of “better, not more”
• Strengthen your ability to communicate the reason for admission and treatment
• Be able to demonstrate the continued need for admission
• Identify the recurring issues that need to be addressed in an appeal

Who Should Attend:

Revenue cycle leaders, physician advisors, chief financial officer, utilization management/review leaders, revenue integrity leaders, HIM director/manager and nursing leadership.