Guides for hospital utilization review and denials
Short, plain-English answers to the questions hospital case management, utilization review and finance teams ask most, reviewed by Aerolib's board-certified physician advisors.
What is the Two-Midnight Rule?
How Medicare's Two-Midnight Rule decides inpatient vs. outpatient status, its exceptions, how it applies to Medicare Advantage, and what documentation needs to show.
Read the guideWhat does a physician advisor do?
A physician advisor helps hospitals make and defend inpatient status and medical necessity decisions. Learn their duties, in-house vs. external models, and when a hospital needs one.
Read the guideHow do you win a peer-to-peer review with a payer?
Practical steps for hospital peer-to-peer reviews with payer medical directors: what to prepare, what to say on the call, and what to do if the denial is upheld.
Read the guideInpatient vs. observation status: what's the difference?
Inpatient vs. observation status explained: how each is billed, what it means for patients and SNF coverage, the MOON and IM notices, and how Condition Code 44 works.
Read the guideHow do critical access hospitals handle utilization review?
How critical access hospitals can run utilization review with a small team: the 96-hour rules, common pressure points, a practical setup and what to measure.
Read the guideHow do you write a medical necessity appeal letter?
What a strong medical necessity appeal letter includes, the five levels of Medicare appeal, common mistakes, and how physician advisors and software speed it up.
Read the guide
Looking for a definition? See the utilization review and denials glossary.
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