Articles Tagged With: necessity
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Physician Judgment Case Might Mean More Risk from FCA
Clinicians make judgment calls every day that do not always turn out to be correct, even when they are made in good faith. A recent court decision regarding the medical necessity of hospice care could put clinicians and hospitals at risk of False Claims Act allegations when judgment calls turn out wrong.
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Health Plans Want Proof It Was Necessary to Admit Patient
Work with utilization managers to understand why these denials are happening. Ensure clinical documentation is detailed enough to support inpatient level of care, and be sure to submit such evidence to the health plan while patients still are in house.
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A Little Coding Knowledge Goes a Long Way Toward Preventing Denials
Patient access staff need far more limited knowledge of coding to perform their jobs. However, it is vital that they learn some basic skills.
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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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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.