CDI Journal - Volume 13, Issue 5

Note from the Advisory Board: Denials—Planning prevention and defense

September 1, 2019
ACDIS Guidance, Denials & Appeals

by Irina Zusman, RHIA, CCS, CCDS
Both ccommercial and public payers now deny about one in every 10 submitted claims, costing health systems up to 2% of net patient revenue, according to a March 2019 article in Modern Healthcare. As the cost of healthcare continues to skyrocket,...Read More »
CDI Strategies - Volume 13, Issue 5

News: ACOs achieved $174 million in savings to Medicare in 2017, AHA says

January 31, 2019
News, Quality & Regulatory

Hospital affiliated ACOs participating in the Medicare Shared Savings Program (MSSP) achieved $174 million in net savings to Medicare.Read More »
CDI Journal - Volume 13, Issue 5

Following the trends: CDI in a changing denials landscape

September 1, 2019
Denials & Appeals

Every year, organizations receive more denials, and payers’ tactics are shifting based on coding rules, clinical criteria, and their own whims.

As a result, many CDI teams find themselves involved with the denials management and appeals process—whether that means weighing in on a case-by-...Read More »
CDI Strategies - Volume 13, Issue 5

News: Hospitals sue HHS over OPPS site-neutral payment reductions

January 31, 2019
News, Outpatient CDI, Quality & Regulatory

Thirty-eight hospitals filed a lawsuit against the U.S. HHS on January 18, alleging that that HHS Secretary Alex Azar overstepped his authority when he finalized an OPPS policy that cuts...Read More »
CDI Journal - Volume 13, Issue 5

Case study: Demystifying the payer side of CDI

September 1, 2019
Denials & Appeals

For CDI professionals working on denials management or appeals in any capacity, the payer side of the equation can often seem mystifying. Recently, ACDIS spoke with a coding professional working for a major private payer organization about her desire to sit for the new Certified Clinical...Read More »
CDI Strategies - Volume 13, Issue 5

Q&A: Using the Glasgow Coma Scale

January 31, 2019
Ask ACDIS, Clinical & Coding

Q: Can you give us advice on coma documentation and coding? We do not use the GCS at our organization.Read More »
CDI Journal - Volume 13, Issue 5

In the trenches: Frontline appeal writing advice

September 1, 2019
Denials & Appeals, Education

According to the 2019 CDI Week Industry Survey, 27.77% of respondents who are currently involved in the denials management/ appeals process work directly by writing appeal letters.

Particularly with the increased focus on clinical validation denials, more and more CDI professionals are...Read More »
CDI Strategies - Volume 13, Issue 5

ACDIS tip: The difference between ANC and WBC count

January 31, 2019
ACDIS Guidance, Clinical & Coding

By Sharme Brodie, RN, CCDS

I’ve been asked in several classes about the difference between an absolute neutrophil count (ANC) and white blood cell (WBC) count and whether they can both be used for evaluating pancytopenia. Let’s take a look at what each of these terms mean and...Read More »

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