Reducing insurer-denied days of care.
To help reduce inpatient expenses, insurers establish utilization management protocols and perform utilization reviews of the care provided in inpatient settings. As a result of these reviews, insurers may deny reimbursement for specific inpatient days or entire admissions. To avoid incurring denied days of care, providers must understand how to apply insurer protocols, streamline care management processes to avoid delays in care, appeal denials, and ensure that managed care contracts contain fair utilization management and quality assurance provisions.
Lefton
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Northeastern Hospital, Philadelphia, PA, USA.
D003363:Cost Control; D019468:Disease Management; D005377:Financial Management, Hospital / Q000379:methods*; D007345:Insurance Claim Review; D007902:Length of Stay / Q000191:economics; D008329:Managed Care Programs / Q000191:economics*; D018802:Patient-Centered Care / Q000191:economics; D011785:Quality Assurance, Health Care / Q000191:economics; D014481:United States; D014600:Utilization Review / Q000191:economics