Claims denials have increased by 11% nationally since the onset of the COVID-19 pandemic, according to an analysis. Almost half of claims denials are caused by front-end revenue cycle issues, including registration/eligibility, authorization, or service not covered. Implementing a process to check eligibility at multiple points throughout the revenue cycle will go a long way in preventing this common denial from occurring.
An analysis of closed medical malpractice claims related to pain management identifies common areas of risk and reveals the COVID-19 pandemic has created new possibilities for liability. A top contributing factor in 90% of all closed claims was insufficient consent between the physician and the patient or family.
In an analysis, 58% of claims against emergency physicians resulted from misdiagnosis. Diagnosis-related allegations were more common in emergency medicine-related claims (58% of claims) than in claims involving internists (42% of claims). The most common final diagnoses were myocardial infarction, pulmonary embolus, and cardiac arrest.
Inaccurate coding causes compliance issues, more denials, lost revenue, and negative patient experiences. More precise and accurate information from the onset sets the stage for correct billing, cleaner claims, and fewer denials.
Health plans are increasingly working with third-party business partners to manage certain operational activities. Although third parties may help save money, for patient access, it could mean more claims denials and authorization hassles.
Medical malpractice insurance is a vital part of any risk management program, but it is easy to assume that whatever coverage you have had for a while is adequate. It may not be, and a regular review of your insurance policies is a good way to avoid nasty surprises.
Risk managers are bracing for what some fear will be a wave of malpractice claims related to COVID-19 care. However, some attorneys say they will not take these cases, arguing the treatment standard is unclear, and substandard care claims cannot be substantiated.
At the UMass Memorial Medical Center ED in Worcester, analyzing medical malpractice data has become a vital patient safety tool. Leaders study adverse event data, root cause analysis, reportable events, and malpractice claims data.