It is not enough anymore to demonstrate that a surgery or imaging test is medically necessary. To receive reimbursement from health plans, patient access staff also must prove it is necessary for the procedure to happen at a hospital.
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.
The last thing patients need in today's climate is to deal with spiteful lawsuits and haranguing collection agencies. Recently released guidance can help patient access be helpful partners for those who need to settle medical bills.