Peer-to-Peer

Documentation – A Key for Reduced Denials

There is one relatively easy way hospitals can reduce claims denials: better clinical documentation. Insurance companies require documentation, and it is often the leading factor in level of care and admission denials. The importance of providing complete documentation never goes away. Treating physicians and utilization review managers must ensure that every admission includes: All the …

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CASE STUDY: Can Peer-to-Peer Reviews Overturn Short Hospital Stay Inpatient Denials?

Inpatient admissions less than two days in length which have been denied by a commercial carrier are appropriate for Peer-to-Peer Review, but not all hospitals and doctors have the time or the will to do these reviews. Once we have moved past the extreme situation of the COVID-19 pandemic, hospitals are going to look hard …

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