title: Using hospital-based case management to reduce payer denials.
abstract: Peninsula Regional Medical Center in Salisbury, Maryland, sought to implement a case management program to reduce a rising number of denied claims for avoidable, nonacute-care inpatient days. Initial efforts focused on consolidating functions rather than monitoring and managing care, and denied claims continued to increase. A revised case management program based on assertive resource management rapidly and substantially reduced claim denials.
authors.affiliation: Phoenix Medical Management, Inc., Pompano Beach, FL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Daniels
mesh_terms: D019090:Case Management / Q000191:economics*; D005377:Financial Management, Hospital / Q000379:methods*; D006297:Health Services Accessibility; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D008396:Maryland; D009936:Organizational Innovation