Prevent Denials and Win Appeals: The Hospital Case Manager's Guide to Revenue Integrity
Paul Arias, RN, BSN, MIS
Softbound Book + bonus CD-ROM
Size: 8.5" x 11" + CD-ROM
HCPro / Opus
(click below for the very best available price for this resource)
Optimizing revenue integrity and turning denied claims into payments just got easier.
Using actual case studies, proven reporting methods, and evidence-based information, this book and CD-ROM package will show you how to prevent denials on the front end by managing level-of-care decisions, distilling payer methodology and contract language, and zeroing in on proper documentation practices.
With strong and compliant processes in place, you’ll know how to track and trend denials. And when you understand their root cause, you can tailor your appeal to the denial at hand and take steps to change the errors that led to the denial. Your copy:
Guides you through the denials management process
Instructs you how to track and trend denials to identify their root cause
Explains your role in denials management, reduction, and prevention
Shows you how to comply with medical necessity standards and use best-practice information to manage level of care determinations
The accompanying CD-ROM contains the forms, templates, and checklists found in the book, so you can download, adapt, and start using them right away.
Who needs to read this book?
Hospital case managers and directors of case management will find Prevent Denials and Win Appeals to be a valuable partner in compliance revenue integrity efforts. Your coworkers in the finance, health information management, and clinical documentation improvement areas will also find it to be an important tool.
With more than 17 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.
Please remember that the government no longer allows a grace period for annual code sets. The new HIPAA Transaction and Code Set Rule requires providers to use national medical code sets that are valid at the time that a service is provided. ICD-9-CM code revisions become effective October 1st each year while CPT and HCPCS code revisions become effective January 1st. In order for you to meet this requirement, you must have the revised CPT, HCPCS, and ICD-9-CM codes in your possession before the implementation dates. The best way to do this is to order your code books early. Review current coding resources.
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