Wednesday, October 21, 2026 | 1:00-2:30pm EDT
Inpatient stop-loss provisions are intended to protect hospitals from catastrophic financial losses when patient charges greatly exceed fixed DRG or per diem reimbursement. Yet stop-loss claims often attract heightened payer scrutiny, resulting in reimbursement reductions through itemized bill reviews, charge deletions, vendor audits, contract interpretation disputes, and post-payment recoupments. This educational webinar provides a practical understanding of stop-loss payment methodologies, how commercial stop-loss differs from Medicare outlier payments, and the common techniques payers use to reduce reimbursement. Through a detailed case study involving a cardiac ablation admission, participants will learn how stop-loss reductions affect hospital billing operations, evaluate the legal and contractual validity of common payer adjustments, and develop effective reconsideration and appeal strategies.
Upon completion of this activity, participants will be able to:
- Identify key inpatient stop-loss reimbursement methodologies and payment calculations.
- Recognize common payer audit and payment-integrity strategies used to reduce stop-loss reimbursement.
- Apply contract and reimbursement principles when evaluating stop-loss payment reductions.