Hospital Access Management – January 1, 2018

January 1, 2018

• Coding Is Must-have Skill for Patient Access: Fix Errors Before Denial Comes

  Coding has become an essential skill for patient access, in light of the surge in claims denials occurring due to the switch to ICD-10. This article will discuss steps patient access can take to ensure correct coding.

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• Make ‘Peer-to-Peer’ Happen Within 24 Hours, Or Face Denied Claim

  Payers are requiring time frames as short as 24 hours for peer-to-peers between the patient’s and payer’s physicians, or they’ll deny the claim. This article discusses several strategies that can make this conversation happen quickly enough to avoid denials.

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• Provide Indisputable Proof: Patient Meets Criteria for Level of Care

  Increasingly, payers are disputing the patient’s level of care, resulting in denied claims. This article discusses ways to help prevent lost revenue.

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• Did Patient’s Insurance Change? Auths, In-network Status May Change Too

  Patients often fail to tell patient access if their coverage changes, and eligibility verification software responses do not always catch it. This article discusses steps that can help prevent claims denials.

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• Payer Says Service Is Non-covered? Patient Access Put in Difficult Position

  Patient access faces difficult conversations with patients if services are non-covered. This article discusses steps to help stop lost revenue.

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• Support Medical Necessity or Face Denials for Stat Diagnostic Tests

  Claims are sometimes deemed uncollectible after the first attempt to appeal a denial is unsuccessful. This article discusses approaches to help ensure payment.

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• ‘Uncollectible’ Claims Just Need Fresh Approach

  Stat diagnostic tests are triggering claims denials because payers dispute the urgency. This article discusses steps patient access can take to increase the chance of a successful appeal.

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