Tag: Hospital Claims

medical necessity errors

Top Error Rates Offer Clues to Denials

The Comprehensive Error Rate Testing (CERT) program grew out of the Department of Health and Human Services Office of Inspector General improper payment rate estimates from 1996 through 2002. Due to sample size restrictions, the Centers for Medicare & Medicaid Services (CMS) assumed responsibility because they had access to more granulated data in 2003. The […]
Denial Management Services

Developing A Hospital Claim Validation Strategy To Prevent Denials

A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable […]