Articles

CDI Journal - Volume 13, Issue 5

Note from the Associate Editorial Director: One giant step for CDI

September 1, 2019
ACDIS Guidance, News

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.”

The 50th anniversary of the moon...Read More »
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 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 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 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 Journal - Volume 13, Issue 5

Regulatory Committee Insight: Rules, regulations, education, and advocacy

September 1, 2019
Clinical & Coding, Quality & Regulatory

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 »
CDI Journal - Volume 13, Issue 5

Setting guideposts: Organizationwide clinical definitions

September 1, 2019
Clinical & Coding, Denials & Appeals

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 »
CDI Journal - Volume 13, Issue 5

Pediatric concerns: Implementing heart failure criteria at Dayton Children’s Hospital

September 1, 2019
Clinical & Coding

by Rachelle Musselman, BSN, RN, Jorde Spitler, BSN, RN, Daniel Lantis, BSN, RN, Joseph E. Ross, MD, and Thomas A. Taghon, DO, MHA
When a condition is ill defined and documented by a provider, it renders the CDI specialist, and later the coding professional, unable to capture the...Read More »

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