The Billing Department has received a denial

The Billing Department has received a denial of payment for an inpatient hospitalization that had an extended length of stay of 10 days. The patient received a number of radiological interventions and treatments for a diagnosis that had a typical length of stay of 5 days. The provider is being asked to explain the lengthy and costly hospitalization in appeal of the denial. Of note, the hospital is in the process of transitioning to a full EHR. Upon review of the patient’s electronic medical record, it is noted that there are a number of exacerbated chronic conditions that were present on admission and were treated during the hospitalization. The provider explained that the chronic conditions delayed the healing process. Coding was engaged to review the electronic documentation and the paper charts to ensure all possible diagnoses and procedures were coded. Determine a possible explanation for the denial of charges based on the extended length of stay?

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