Wake-Up Call
The Inpatient Downgrade Isn't a Clinical Dispute. It's a Contract You Already Signed.
Stricter criteria than Medicare and a contract promising CMS-alignment — a 30 percent cut the page already settles. From Jefferson Health v. Aetna: three clauses to audit, the scenarios that get downgraded, and a workbook that scores your leverage.
- Three contract clauses to audit
- Five high-risk scenarios
- The CMS rule citation
What's inside
A 7-page audit card and 7-tab workbook.
The three clauses, the high-risk scenarios, and the CMS citation behind the Two-Midnight argument.
Three Contract Clauses to Audit
The audit card's core: CMS-alignment language, severity-criteria authority, and payment-tier definition. What to look for in each, and why.
Five Scenarios Most Likely to Be Downgraded
Chest pain rule-out, TIA/stroke workup, COPD/asthma, cellulitis, and post-op complications — the admissions where severity interpretation diverges most.
The One CMS Rule Citation
The Two-Midnight Rule (42 CFR 412.3) paired with the MA parity requirement (42 CFR 422.101(b)(2)) — the federal floor barring stricter criteria.
The Contract Clause Audit, Scored
A workbook tab that scores each contract 0 to 2 across the three clauses for a leverage score out of 6, with a strong, moderate, or weak read.
CMS vs. MCG vs. InterQual
A side-by-side severity-criteria reference: authority basis, admission standard, stringency, and where MCG and InterQual can supplement.
Decision Tree & Readiness Scorecard
A five-criteria tool scoring inpatient defensibility out of 7 per admission, plus a 12-question quarterly review of your organization's posture.
Why RapidClaims
Built for the hardest coding challenges in healthcare.
While other vendors chase high-volume, low-complexity work, RapidClaims is built for the coding that actually moves your net collection.
>98%
Coding accuracy
Across 25+ specialties, including the complex ones competitors avoid.
40%
Fewer denials
Documentation gaps caught at the point of code, before submission.
170%
Coder productivity
More charts per coder — without adding a single FTE.
25+
Specialties supported
Depth in the hardest specialties, not just the easy volume.
82.5%
Charts auto-coded
Autonomous at an enterprise-grade accuracy threshold.
11k+
Organizations of signal
Operational data behind every coding recommendation.
Results
The numbers speak for themselves.
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Connectivity
Works with your existing systems
RapidClaims integrates with all major EHRs. No rip-and-replace. No disruption.
Integration Capabilities
Security
Built for Healthcare. Secured for Enterprise.
SOC 2 Type II
Independently audited security controls
HIPAA
Full adherence to healthcare's most rigorous framework
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Aligned with healthcare's most rigorous framework
256-bit Encryption
Data encrypted at rest and in transit