Prevent Denials and Win Appeals: The Hospital Case Manager's Guide to Revenue Integrity

Optimizing revenue integrity and turning denied claims into payments just got easier.

Using actual case studies, proven reporting methods, and evidence-based information, this book and CD-ROM package will show you how to prevent denials on the front end by managing level-of-care decisions, distilling payer methodology and contract language, and zeroing in on proper documentation practices.

With strong and compliant processes in place, you'll know how to track and trend denials. And when you understand their root cause, you can tailor your appeal to the denial at hand and take steps to change the errors that led to the denial. Your copy:

- Guides you through the denials management process
- Instructs you how to track and trend denials to identify their root cause
- Explains your role in denials management, reduction, and prevention
- Shows you how to comply with medical necessity standards and use best-practice information to manage level of care determinations

The accompanying CD-ROM contains the forms, templates, and checklists found in the book, so you can download, adapt, and start using them right away.

Who needs to read this book?

Hospital case managers and directors of case management will find Prevent Denials and Win Appeals to be a valuable partner in compliance revenue integrity efforts. Your coworkers in the finance, health information management, and clinical documentation improvement areas will also find it to be an important tool.