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