BC Advantage - 2007 Issue 9

Are You Billing the Most Appropriate Setting?

Admission necessity denials-cases in which care could have been safely and effectively provided in an alternate settingcontinue to be the most costly type of Medicare payment error. According to a study commissioned by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, admission denials constitute 83 percent of the total net dollars in error and 61 percent of the total gross (or absolute) dollars in error. Short hospital stays, particularly one-day stays, are even more prone to payment errors.These findings come from the latest analysis of short-term...

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