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Podcast: A better approach to clinical appropriateness in claims payment

 

Podcast: A better approach to clinical appropriateness in claims payment

Are you asking the right questions when determining whether your claims are clinically appropriate? For example, were the diagnoses billed supported by clinical indicators in the records? Was the correct clinical setting assigned and billed based on nationally recognized guidelines? The process of reviewing claims and charts for clinical appropriateness is crucial for your business as you look to curb improper payments and reduce fraud, waste, and abuse. 

Listen to Cotiviti's podcast to learn how to:

  • Ensure claims are clinically appropriate through a combination of coordinated technology and human review 
  • Hire and train nurses for effective and up-to-date review of claims and charts
  • Discuss clinical appropriateness with providers without increasing abrasion

 

About the Author

As senior manager of content marketing, Jeff supports Cotiviti's customers by developing a wide range of healthcare communications including blog posts, white papers, case studies, podcasts, and videos. Before joining the organization in 2016, he worked in journalism as the morning host and news director for KCPW, a public radio station in Salt Lake City. Jeff holds a bachelor’s degree in broadcast journalism from the University of Southern California and an MBA from the University of Utah.

Profile Photo of Jeff Robinson