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At least 613 records · Page 34Linked to original sources
PubMed2002

When the HMO says no.

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Employee Retirement Income Security Act↗
PubMed2002

Effective claims denial management enhances revenue.

Claims denial management can enhance revenue in times of declining payment and increasing cost pressures. Denials usually arise from process problems leading to inadequate documentation. A denial management team should oversee prospective prevention and claims recovery. Prospective prevention minimizes denials by defining scope of service, tracking causes for denials, and improving related processes. Claims recovery improves chances of recovering denied payment.

Aged↗
PubMed2002

[Complaints regarding lumbar disk herniation treatment reported to the Norwegian Compensation System].

BACKGROUND, MATERIAL AND METHODS: Over the 1993-99 period the Norwegian Patient Compensation System made decisions in 4,041 orthopaedic treatment injury cases. 700 cases were randomly selected and analysed in order to elucidate the reasons for complaints. 58 cases were related to lumbar disc herniation treatment. RESULTS: Of these 58 cases, 52 complaints were lodged against hospitals; six against primary health care providers. Seven patients had been primarily observed or non-operatively treated; 55 were eventually operated on, eight with recurrent disease. Nearly all complaints were related to the outcome of surgery (72%) and delay of diagnosis/surgery (21%). Several serious complications occurred; one patient died. Five patients had cauda equina syndrome; a further seven had neurological deficits from distal spinal nerve roots. In 17 cases (29%) the complaints were accepted, while 41 complaints (71%) were rejected. INTERPRETATION: In lumbar disc herniations both surgery, observation and non-operative treatment may lead to severe complications. It is important to select the right patients for surgery and to provide good information.

Adult↗
PubMed2002

Preventing & dealing with ESRD claim denials.

Nephrology practices and dialysis clinics should structure their billing procedures and specifically designate staff for tracking claims and appealing denials. Timeliness are careful navigation of denial process procedures are keys to optimizing reimbursement. Clearly, the dynamic nature of health care reimbursement demands that facilities become even more savvy in managing challenging reimbursement issues. Billing staff who know how to prevent denials whenever possible and confidently manage appeals when denials occur are instrumental to ensuring appropriate payment for medical services.

Humans↗