Case Study

Peer-to-peer for Inpatient Denial

Case Study: Sepsis Presents Challenging Denial

CLINICAL SUMMARY This case involved a 74-year-old patient who presented with chills and a temperature of 103°F. The patient had a past history of hypertension, arthritis and right total shoulder replacement in January 2021. Chest x-ray showed coarse perihilar and interstitial markings, likely viral or reactive. A CTA chest was negative for pulmonary embolism or […]

Case Study: Sepsis Presents Challenging Denial Read More »

Case Study bilaterial pneumonia denial overturned

Case Study: Bilateral Pneumonia

CLINICAL SUMMARY: Bilateral Pneumonia A 23-year-old nonverbal female patient arrived in the emergency department with her parents who said she had a fever and heavy breathing since the morning. The patient’s medical history included Lennox-Gastaut Syndrome, severe mental retardation, seizure disorder, recurrent aspirations, recurrent pneumonia and vagal nerve stimulator. Her parents said she had been

Case Study: Bilateral Pneumonia Read More »

CS-chest-pain-non-cardiac denial overturned

Case Study: Chest Pain, Non-cardiac Can be Difficult to Get Admission Status Correct

Chest pain is one of the most common ER diagnoses. For those patients who require hospital admission, getting the admission status correct and paid by the insurance company can be tricky. One such case involved a patient who arrived in the ER with chest pain presumed due to unstable angina (TIMI 3). The patient was

Case Study: Chest Pain, Non-cardiac Can be Difficult to Get Admission Status Correct Read More »

Scroll to Top