CM protocol results in decreased denials.
Payer denials for inappropriate observation patient status dropped 50% after hospital delegated responsibility for determining patient status to CMs. All admitted patients are reviewed by a CM for admission status. CMs use Medicare guidelines and InterQual criteria for medical necessity determination.
D019090:Case Management / Q000191:economics / Q000592:standards*; D004469:Economics, Hospital; D004636:Emergency Service, Hospital / Q000458:organization & administration; D016519:Hospitals, Religious; D007349:Insurance, Health, Reimbursement; D009820:Ohio; D019982:Organizational Case Studies; D010343:Patient Admission / Q000592:standards*; D010865:Pilot Projects