Case Management

Tip: Beware of improperly submitting provider liable claims

Case Management Weekly, July 13, 2011

Don’t make the mistake of submitting a provider liable claim because a case doesn’t meet the hospital’s admission screening criteria or because the patient stayed only one day.

Submission of a provider liable claim is dependent on utilization review physician(s)’ review and determination that the admission was not medically necessary or denial by a Medicare Administrative Contractor (MAC), Recovery Audit Contractor (RAC), or Comprehensive Error Rate Testing (CERT).

This week’s tip is adapted from Observation Services, Third Edition published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.   

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at An answer to your question might appear in a future issue of Case Management Weekly.

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