Can Your Hospital Handle Rising Payer Denials Alone
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Short Hospital and Healthcare awareness about Insurance and Medicare Payer Medical Necessity Denials and Appeals
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Can Your Hospital Handle Rising Payer Denials Alone
- 1. PAYER DENIALS ARE RISING CAN YOUR HOSPITAL CARRY THIS BURDEN ALONE? 16000 Park Ten Place Houston, Texas 77084 Tel. 832-321-5637 Fax. 281-717-5819 PMA@medicalappeals.org PREMIER MEDICAL APPEALS
- 2. Hospitals require an experienced and winning team to appeal Payer denials Premier Medical Appeals Understanding of Payer process and policy Best Practice and Clinical Guideline expertise Clinical experience finding “Medical Necessity” in EMR documentation Coding compliance knowledge Strong communication and coordination
- 3. Hospital’s options/costs to generate appeal letters Internal via Nurse Case Managers ($85,000 mean salary for hospital RN case manager in Houston) • Fixed headcount/ competing responsibilities/ variable number of denials limits ability to appeal 100% • Compensation and benefits per Nurse Case Manager range from $106,000 to $119,000 • What staffing level is optimal??? • Outsourced model – Premier Medical Appeals • Ability to scale based upon numbers of denials – can appeal 100% • Modest fee per appeal • Manage costs – pay for services as needed