Aetna's new Medicare Advantage policy will approve inpatient admissions but pay many at observation rates with no appeal rights. Revenue cycle leaders need immediate strategies.

86% of claim denials are avoidable, yet providers spend $19.7B annually fighting policy-related denials. Learn how to build a robust payer policy database that tracks frequent policy changes, enables real-time claim validation, and reduces denials. Get step-by-step implementation strategies, team structure blueprints, technology integration guides, and proven tactics to achieve 95% policy compliance and same-day policy updates.

Clinical Documentation Improvement teams have mastered denial prevention through real-time collaboration and concurrent review. Discover how to transform your denial management program using CDI best practices: pre-submission audits, physician query protocols, cross-functional teams, and predictive analytics. Get actionable strategies to prevent documentation-driven denials, improve appeal overturn rates, and reduce administrative costs.

DRG 871 sepsis downgrades represent 70% of hospital revenue loss, but they're preventable. Payers deny claims lacking SOFA scores, trending lactate, and organ dysfunction data. This guide reveals root causes from EMR gaps to training deficits, plus your implementation roadmap: EMR order sets, pre-bill reviews, role-specific training, and KPI tracking. Turn your biggest denial risk into revenue protection.