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Inpatient and outpatient claims undergo thousands of
edits looking at patient status, diagnosis and
procedure data, services provided and demographic
data – they either pay or reject or deny.
Rejections and denials are not contractual write-offs.
This distinction is an important one.
Patients remaining in acute care past the average LOS are
estimated to cost hospitals over 50 million dollars per year.
Hospitals are fined (or placed under a Quality Improvement
Agreement) due to patients being admitted as inpatients when
they do not meet inpatient admission criteria. (RAC
Perplexing Points to Ponder