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White Papers

Top Five Reasons for Denials

Help your hospital get out of denial by addressing the top five reasons for claim denials. When the causal reasons are understood, most denials are both preventable and appealable. The top five reasons given for claim denials are:
  1. Inpatient versus Outpatient assignment
  2. Authorization issues such as day/s not considered medically necessary, or untimely clinical update
  3. No admission order
  4. 2–Midnights rule
  5. Medical necessity not met
Read more about each of the top five reasons for denials and how to address issues before they occur in a claim, in the following online article on utilization management: http://www.craneware.com/resources/white-papers/rac-utilization-management Do you have an interesting denial story to share? We’d love to hear from you.