title: Hospital's proactive approach to RAs pays off.
abstract: Alamance Regional Medical Center in Burlington, NC, appeals all Recovery Auditor denials, up to administrative law judge level, and works to avoid denials by carefully scrutinizing admissions for medical necessity. The utilization review department reviews all admissions for medical necessity, regardless of where they come in to the hospital. Care coordinators staff the emergency department seven days a week and work with physicians on medical necessity and patient status. Computer software tracks every record request and denial and appeals quickly.
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D014487:Centers for Medicare and Medicaid Services, U.S.; D006769:Hospitals, General / Q000191:economics*; D007349:Insurance, Health, Reimbursement; D009657:North Carolina; D019982:Organizational Case Studies; D010343:Patient Admission; D014481:United States; D019564:Unnecessary Procedures