Patient status: Five tools to conduct internal audits

Editor’s note: This article is the first in a two-part series on patient status.

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, hospitals need to employ several careful oversight procedures, including:

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