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| Health Care Auditing Strategies |
| July 2008 |
| Patient status: Five tools to conduct internal audits |
| Editor's note: This article is the first in a two-part series on patient status.
In an era of greater accountability and enforcement, hospitals and treating physicians will be increasingly responsible for complying with Medicare's medical necessity criteria for admissions and determining patient status.
Exercise oversight methods
To improve patient care and reduce the occurrence of claims denials or underpayments, hospitals need to employ several careful oversight procedures, including:
Retrospective guidance of its utilization review (UR) committee
Internal audits
Prospective guidance of case management protocol (CMP) |
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