Using hospital-based case management to reduce payer denials.
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.
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Phoenix Medical Management, Inc., Pompano Beach, FL, USA.
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