Healthcare Revenue Loss; The Struggle is Real
Photo and introduction courtesy Racmonitor
"Provider-based clinics and associated operations have become very popular for hospitals because increased reimbursement results from filing both a facility and a professional claim. But all of that could change due to a potent storm that's gaining energy on the horizon. Once again, hospitals are at the storm's vortex." Racmonitor
Premier Medical Appeals is raging against the storm. Our mission is to stop the outpouring of healthcare dollars needed to keep Hospital and Clinic doors open to those who need MEDICAL CARE.
We specialize not only in Inpatient denials and appeals management, but have a successful overturn rate with Outpatient denials as well.
Outpatient clinics deliver a valuable service to our communities. CMS and commercial payers have in place contracting and criteria language which states they have the right to deny and inpatient hospital stay if their reviewers feel that level of care wasn't appropriate, and care should have been given on an outpatient basis. This being said, (I will have a separate article on these criteria) patients are then directed to Outpatient clinics. These clinics offer care, education and the ability to allow patients to stay home. Still they are and will suffer CMS, Managed Care and Commercial Payer audits, revenue recoupment and denials of payment for services.
How will facilities stand up to the storm? Will any find shelter from the loss of revenue? It’s doubtful that there will a majority of facilities left untouched. Much like Hurricane Katrina struck and devastated areas from the Florida coast on its way to crushing Louisiana in 2005, the loss will be great. Not only the loss from the main impact, but the domino effect it had on the rest of the country in the economic struggle and outpouring of support to hardest hit areas, so too will these massive audits effect our healthcare economy.
It is proven by CMS gaffing model that not unlike the path of summer Hurricanes, Healthcare audits are more highly concentrated in strategic areas of our country.
To find out what can be done, RAC updates and what we are doing visit me or Premier Medical Appeals on LinkedIn as well or tweet me @Venita.Crow@PMA