Many payers are not requiring concurrent clinical review and instead are focusing solely on a discharge date and discharge planning needs. They also state they are reserving the right to require retrospective clinical information. How are others managing this? Are we worried about in the future having to pull together 2 months of information when we are opening back up to do elective admissions and resuming higher capacity?
Are we going to have to pull together 2 months of information when we are opening back up to do elective admissions?
Yes we are concerned as this could happen. We just do not know to what magnitude it will. Unfortunately, this may be a wait and see.
• In my CM department my staff continued to meet all CMS requirements pre-COVID including authorizations as the payors will retrospectively deny and with reimbursement being challenged we cannot afford the denials that potentially will occur and wait post appeals for reimbursement.
• We are sending reviews as well in anticipation of retro denials.
• Still getting audits & denials from Medicaid
• Status & 2MN rule still active
• Err on side of caution & keep up to the extent you can
• Refrain from using those flexibilities until they are really needed