Corporate Compliance

Patient status: Five tools to conduct internal audits

Strategies for Health Care Compliance, September 1, 2008

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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, a hospital needs to employ several careful oversight procedures, including:

  • Retrospective guidance of its utilization review (UR) committee
  • Internal audits
  • Prospective guidance of case management protocol (CMP)

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Strategies for Health Care Compliance.

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