AD HOC LLOC

DON’T GO INTO HOC…AD HOC
Too many facilities are retaining patients at the current level of care after further care at this level has been denied by the payer. The alternative is to provide the level of care your clinical staff believes is warranted and empower your designated staff (e.g. UR, UM) to negotiate an ad hoc agreement with the payer at a lower rate in lieu of discharging the patient. Clearly the rate you get is greater than a denial, but typically it is also greater than the net an appeal will yield.

Yes ARA is giving away a big tactical game plan. If your chart is not strong enough to support the higher level of care the odds of winning an appeal drops from 80+% to less than 50%. The most common examples include negotiating rates from Acute to PHP, SNF or RTC. Sometimes your clinical staff will agree that a patient is no longer acute but their home situation is too precarious for the patient to return while attending PHP, or the family is unable to provide the care of a SNF or RTC, or simply a bed is not available. When a bed is not available for the lower level of care, these days are referred to as Days Awaiting Placement and have legitimate payment potential.