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 »
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 »
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 »
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 »