Healthcare leaders from across the country recently participated in a webinar led by Ronald Hirsch, M.D., vice president of the regulations and education group at Accretive Health’s AccretivePAS® division. The topic, “Medical Necessity: Beyond Inpatient or Observation” was hosted by America’s Essential Hospitals (formerly National Association of Public Hospitals and Health Systems) and outlined the regulations regarding medical necessity, provided examples of medical necessity guidelines and the processes that hospitals can use to ensure their care meets these guidelines.
“Case managers and physicians spend much of their time trying to sort out the nuances of the decision to admit a patient as an inpatient or to place them on observation,” Dr. Hirsch said. “Because the decision is confusing, the recovery auditors have based many of their denials on this classification…The new frontier is the decision of whether the care provided was itself medically necessary.”
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The healthcare professionals who participated were interested in learning about the regulations surrounding coverage and payment for medical and surgical care, understanding the process used to develop coverage guidelines, and how to identify how physicians can assure that the care they provide is covered and reimbursed.
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About AccretivePAS®
AccretivePAS® is a comprehensive physician advisory medical necessity solution that helps hospitals and medical facilities confirm their navigation of the regulatory environment so that compliance improves.
About Accretive Health
At Accretive Health, our mission is to help our healthcare clients strengthen their financial stability and deliver better care at a more affordable cost to the communities they serve, increasing healthcare access for all. For more information, visit www.accretivehealth.com.
