How does FIT handle medical denials?
This is a common question, as our clients don’t want to be bothered by reviewing “findings” that turn out to be unbillable. In the case of denials, HWC has all the transaction level data it needs to identify denial allowances in the system; we exclude denied amounts from our findings. In the case of a hospital who hasn’t posted all of their denial allowances, HWC has all the contracts and has built edits into the system that help us ensure that the discrepancies between our calculated amount and the hospital information are true underpayments. For example, discrepancies that are exactly equal to, or multiples of, one day at per diem rates usually indicate an unposted denial allowance. We also check the account notes for evidence of a denial. Don’t worry, we identify the vast majority of denial exceptions and delete them long before we present our findings to you.
