3 Considerations for Denial Avoidance
3 Considerations for Denial Avoidance Imagine a scenario where a patient needs a necessary surgery like a prostatectomy due to prostate cancer. When the provider and patient decide to move forward with the surgery, it’s essential to set a precedent by talking to both the patient and the insurance company to find out what the […]
5 Tips for Healthcare Providers to Better Prevent DRG Downgrades
Why learn to prevent DRG downgrades? The clinical downgrading of diagnosis-related groups (DRG), or DRG downgrades, has become an extremely problematic issue for healthcare providers over the past decade. Overall, denials related to DRGs are increasing; downgrading target DRGs without even requesting documentation can also happen. One healthcare system, for example, found that DRG downgrades […]