The American Journal of Medicine
Volume 117, Issue 9 , Pages 629-635 , 1 November 2004

Reimbursement denial and reversal by health plans at a university hospital

Received 25 August 2003 ,Accepted 4 June 2004.

References 

  1. Wachter RM , Goldman L . The emerging role of “hospitalists” in the American health care system . N Engl J Med . 1996;335:514–517
  2. Wachter RM , Katz P , Showstack J , et al.  Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education . JAMA . 1998;279:1560–1565
  3. Felt-Lisk S , Mays GP . Back to the drawing board: new directions in health plans' care management strategies . Health Aff (Millwood) . 2002;21:210–217
  4. Lefton R . Reducing insurer-denied days of care . Healthc Financ Manage . 1996;50:52; 54,56-58
  5. Hammer DL , Kerson TS . Reducing the number of days for which insurers deny payment to the hospital: one primary objective for a newly configured department of case management . Soc Work Health Care . 1998;28:31–49
  6. 3M. All Patients Diagnosis Related Groups Definitions Manual. 8th ed. 3M Health Information Systems 3M Health Information Systems, Wallingford, Connecticut;; 1990.
  7. HCIA. The Guide to the Managed Care Industry, 2000 Edition. Baltimore, Maryland: HCIA, L.L.C.; 1999.
  8. Fine MJ , Auble TE , Yealy DM , et al.  A prediction rule to identify low-risk patients with community-acquired pneumonia . N Engl J Med . 1997;336:243–250
  9. Fine MJ , Medsger AR , Stone RA , et al.  The hospital discharge decision for patients with community-acquired pneumonia (Results from the Pneumonia Patient Outcomes Research Team cohort study) . Arch Intern Med . 1997;157:47–56
  10. Fine MJ , Hough LJ , Medsger AR , et al.  The hospital admission decision for patients with community-acquired pneumonia (Results from the pneumonia Patient Outcomes Research Team cohort study) . Arch Intern Med . 1997;157:36–44
  11. Halm EA , Fine MJ , Marrie TJ , et al.  Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines . JAMA . 1998;279:1452–1457
  12. Walker LM . Just how short can hospital stays be . Med Econ . 1994;71:37–38
  13. Sills MR , Huang ZJ , Shao C , et al.  Pediatric Milliman and Robertson length-of-stay criteria: are they realistic . Pediatrics . 2000;105:733–737
  14. Rutledge R . An analysis of 25 Milliman & Robertson guidelines for surgery: data-driven versus consensus-derived clinical practice guidelines . Ann Surg . 1998;228:579–587
  15. Bauchner H , Vinci R , Chessare J . Milliman and Robertson—going in the wrong direction . Pediatrics . 2000;105:858–859

PII: S0002-9343(04)00482-6

doi: 10.1016/j.amjmed.2004.06.025

The American Journal of Medicine
Volume 117, Issue 9 , Pages 629-635 , 1 November 2004