FEATURES 9 CDI in a changing denials landscape 13 The payer side of CDI 15 Frontline appeal writing advice 20 Organization-wide clinical definitions...Read More »
By Melissa Varnavas
On July 20, 1969, American astronauts Neil Armstrong and Edwin “Buzz” Aldrin landed on the moon. In taking his first step, Armstrong uttered the historic words, “That’s one small step for man, one giant leap for mankind.”
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 »
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 »
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 »
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 »
By Candace Blankenship, BSN, RN, CCDS
The role of the CDI specialist is in constant flux. When I started out as a CDI specialist, my hospital wanted me to focus on reimbursement. Having one focus gave me a clear path and little conflict when I was educating and querying providers...Read More »
On February 23, 2016, the Journal of the American Medical Association published new clinical definitions for sepsis and septic shock, dubbed “Sepsis-3.” In the three years since then, a host of analyses and conflicting documentation and coding requirements have caused not only consternation but...Read More »
