7 Main Failures Leading to Payment and Resolution Delays

UTILIZATION This category accounts for 25% of all denied charges and includes the clinical areas of medical necessity, pre-authorization, DRG downgrades and experimental treatments. Insurance companies will often challenge whether a specific treatment was medically required, whether the level of care provided corresponded to the underlying morbidity, or whether the length of stay was justified.…

Importance of Chargemaster Upkeep

ENSURING HOSPITAL CHARGEMASTER MAINTENANCE Hospital chargemaster maintenance is the primary responsibility of the designated team or coordinator. Maintenance is a continuous process that ensures all services are accurately charged, the hospital is compliant with government regulations for pricing, and the organization receives accurate reimbursement. Hospital chargemaster maintenance can be especially challenging as public and private…