Inpatient Stay Denial

Diabetic patient testing blood

Case Study: Poorly Controlled Diabetes Inpatient Denial Overturned

Case Study, Denial Management / By

Hospital utilization management requires constant communication between the utilization management team and physician advisors as well as continuously reassessing observation cases for possible conversion to inpatient status. Missing these opportunities leads to increased observation rates, reduced revenue, and potential Patients requiring ongoing medical care beyond the observation period should be constantly reassessed for inpatient status …

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Patient with total knee replacement

Case Study: Total Knee Replacement Inpatient Denial Overturned

Case Study / By

Inpatient stays for procedures commonly done on an outpatient basis can lead to denials. But appealing the denials does have promise. A recent denial for a total knee replacement that was overturned due to the patient’s high risk factors and complex medical history. CLINICAL SUMMARY: Total Knee Replacement A 67-year-old patient underwent a left total …

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