Health Information Management

Tip: Ensure medical necessity to curb outpatient revenue loss

APCs Insider, July 24, 2009

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Providers must ensure the medical necessity of procedures they perform. To reduce revenue loss, assess your process and re-dedicate resources to identify the root of medical necessity problems.
 
Consider the following tips:
  • Rededicate resources. Restructuring resources should be a top-down decision among hospital administration staff. The entire organization should participate in this decision.
  • Create urgency. Generating a common concern for outpatient medical necessity among staff members from different departments is important. Establish multidisciplinary teams to identify ways to reduce waste and improve processes.
  • Change your focus. Shift your focus to the outpatient department. Most problematic short stays originate with observation patients and those who enter the system via the ED. Urge staff members in outpatient departments to work together, share information, and improve communication with each other.
  • Automate your review process. Use software to automate your case management and utilization review process. Software solutions also support physicians by providing access to information that can help them determine accurate patient status.
 
This tip is adapted from the article “Ensure medical necessity to curb outpatient revenue loss” from the August issue of Briefings on APCs.



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