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The
Challenge:
The
executive team of a large hospital wanted to reduce costs by
decreasing unnecessary denials for outpatient procedures and
inpatient stays.
Part of the plan involved providing information to the
physicians and staff about health plan criteria and how denials
were issued.
The
Solution:
Gordian
Health Management was contacted to provide classes for hospital
personnel and admitting physicians. These classes included national
criteria for case determination, managed care basics for
decision-making, and the financial impact of unnecessary denials
for services rendered.
The
Benefits:
Following
the implementation of the entire plan, rates of unnecessary
denials decreased dramatically and physician support for
administrative initiative at the hospital improved significantly. The result
was decreased facility cost and improved revenues.
While
education is not solely responsible for the improvement, a
knowledgeable medical staff is essential in supporting
administrative initiatives.
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