The majority of our medical necessity denials stem from the following:

  • Advanced Poll:
    The majority of our medical necessity denials stem from the following:
    • Incorrect status (admission vs. observation)
      29.7%
    • Incorrect setting (general medical floor vs. monitored or ICU)
      0.99%
    • Inadequate provider documentation
      47.52%
    • Insufficient case management coverage
      2.97%
    • Other
      6.93%
    • Not a problem
      0.99%
    • Not applicable
      10.89%