Revenue management. To pay or not to pay.
Since the claim is the common means of payment communication, control of the current payment process is possible through a positive effort by each hospital to formulate and employ a strategy to maximize earned reimbursement through attention to detail in preparing each claim. If not, hospitals will have to be content to let insurors dictate, through their statistical analysis of less-than-exact claims, not only what will be paid for each patient, but also what medical services are appropriate. It is up to each hospital to develop control of the "to pay or not to pay" decision before the option disappears.
D005376:Financial Management; D005377:Financial Management, Hospital; D007182:Income; D007256:Information Systems / Q000592:standards*; D007341:Insurance / Q000592:standards*; D007344:Insurance Claim Reporting / Q000592:standards*; D008331:Management Information Systems / Q000592:standards*; D014481:United States