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p.29

 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

   recoupments!)

Perplexing Points to Ponder

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