Reducing insurer-denied days of care

The refusal of insurers to reimburse healthcare providers for certain days of care or entire admissions can lead to losses amounting to millions. However, providers can avoid insurer-denied days of care by assigning a quality assurance coordinator and peer review physician to dispute cases of denials, evaluating processes that contribute to denied days and studying utilization and quality provisions in managed care contracts.
To help reduce inpatient expenses, insurers establish utilization management protocols and perform utilization reviews of the care provided in inpatient settings. As a result of these reviews, insurers may deny [...]