Contract_Language_Audit_Workbook.xlsx

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1	CONTRACT LANGUAGE AUDIT WORKBOOK
2	Based on Jefferson Health v. Aetna federal complaint (April 6, 2026) and CMS Two-Midnight Rule \| RapidClaims
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4	WHY THIS WORKBOOK EXISTS
5	Aetna's Level of Severity Inpatient Payment Policy auto-approves 1-4 midnight stays as inpatient but pays them at observation rates (~30% less). Jefferson Health sued April 6, 2026. Three other commercial payers have similar policies on the desk. This workbook gives you the contract-clause audit framework, clinical scenario library, and CMS-vs-payer severity comparison to identify your contractual leverage before similar policies activate.
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9	WHAT'S INSIDE
10	TAB	WHAT IT CONTAINS	WHEN TO USE	TIME
11	1. README	How to use, color legend, disclaimer	First time only	5 min
12	2. Clinical Scenario Library	5+ scenarios most likely to be downgraded with risk scoring	Per contract review	20 min
13	3. Contract Clause Audit	3-clause scoring per payer with CMS-alignment check	Per payer contract	30 min
14	4. Severity Criteria Comparison	CMS vs. MCG vs. InterQual side-by-side reference	Reference	10 min
15	5. Two-Midnight Decision Tree	Inpatient vs. observation decision logic with documentation anchors	Per admission review	5 min
16	6. Readiness Scorecard	12-question quarterly review with live score	Quarterly	15 min
17	7. Sources & Change Log	Primary sources, version history, disclaimer	Reference	—
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20	COLOR LEGEND
21	LEVEL	MEANING	BG	TEXT
22	STRONG	Contract language supports CMS-alignment argument	D5F0E1	0D7680
23	MIXED	Contract is ambiguous — counsel review needed	FDEBD0	D68910
24	WEAK	Contract grants payer unilateral severity authority	FAD7D7	8B0000
25	EDITABLE	Enter your data in yellow cells	FFF9DB	1A1A1A
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27	DISCLAIMER
28	This workbook is an internal CFO, revenue cycle, and managed-care education tool. It does not replace legal counsel. Contract language interpretation, regulatory citations, and clinical severity criteria vary by jurisdiction, plan type, and case law. Always consult counsel before raising contract disputes with payers. The Jefferson Health v. Aetna litigation is ongoing — outcomes are not guaranteed and any specific contract argument should be evaluated against current case law. Clinical scenario risk estimates are directional. Not legal or clinical advice.
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