Denials of reimbursement for hospital care.
Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large teaching hospital. The results showed a denial rate of less than 1.5% of all patients reviewed, higher denial rates among certain clinical services, higher rates of reviews among certain services only partially explained by volume of admissions, and a lack of patient criteria to receive care in the inpatient setting as the most frequent reason given for denial.
Murray
Mary Ellen
ME
School of Nursing, University of Wisconsin, Madison, USA. memurra1@facstaff.wisc.edu
Henriques
Jeffrey B
JB
D003211:Concurrent Review; D006297:Health Services Accessibility; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics*; D011639:Public Opinion; D014481:United States