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 skills with
payers
 Focus on Payer Appeals

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