Hospitals lose millions of dollars each year to decisions made before a patient is ever discharged. The most consequential is often the first: whether to classify a patient as observation or inpatient — a single choice that can alter reimbursement by thousands of dollars per case.
Here’s what makes the problem hard to see. The largest losses rarely arrive as denied claims. A low denial rate can look like success while under-statusing and under-coding quietly conceal underpayment. Meanwhile, payers are reviewing claims faster and with more sophisticated analytics than ever.
For hospitals status determination, utilization management, clinical documentation integrity, coding and claims teams can no longer operate in silos. This session will lay out what it takes to run them as one continuous, accountable process.
The session will cover:
- Why observation vs inpatient decisions quietly compound to erode overall hospital margin
- How unclear ownership and handoffs around denials allow issues to fall through the cracks
- What it takes to connect status determination, documentation, coding and appeals into one continuous process
- How hospitals can reduce vulnerability to hidden revenue loss