In light of current governmental regulatory oversight, I am appalled that health care facilities (hospitals) squander revenue by the refusal to attempt appealing services rendered then denied by Medicare due to lack of medical necessity.
At what point, do we allow the federal government to determine what is MEDICALLY NECESSARY and begin to communicate the patient’s accurate severity of illness in order capture appropriate resource consumption and acquire justified reimbursement.
As health care professionals, we must accept the responsibility of verifying consumption of resources by communicating accurate severity of illness, intensity of service, medical necessity and quality of care as appropriate. If we ignore this responsibility we are allowing the federal government and third party fiduciary entities to control the practice of medicine and clinical acumen becomes obsolete.
Appropriate reimbursement will not be attained without proactive action strategies to denials implemented and practiced with diligence.
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