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Incorrectly labeling Medicare as the primary insurance, or missing payers that are primary to Medicare, often costs facilities greater reimbursement and puts hospitals at risk for audits/fines.
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Clear and open lines of communication between the clinical team and patient access is the single best way to prevent claims denials due to no authorization, according to Aaron Robison, CHAA, a patient financial advocate at University of Utah Health Care in Salt Lake City. However, this step remains a significant challenge for the department.
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Payers are requiring authorizations for many additional procedures, which results in increased claims denials and dissatisfied patients.
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Readmissions are not just a hospital problem. They are a problem that extends across the continuum of care, and providers at all levels of care must work together to solve it, says Tania Daniels, PT, MBA, vice president of patient safety for the Minnesota Hospital Association.
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With the dual goals of increasing operational efficiency and promoting patient-centered care, Northwest Community Hospital in suburban Chicago revamped its care delivery model, adding a new role of clinical care coordinator to facilitate smooth and timely transitions from admission to discharge.
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Readmissions are a big factor in Medicare spending per beneficiary since an additional hospital stay adds significantly to the total cost of care, points out Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, director of inpatient compliance for Administrative Consultant Services, a Shawnee, OK-based healthcare consulting firm.
