Speaker Q&A: Completing the circle

The importance of CDI involvement in denial management cannot be stressed enough. Join associate attorney, and returning ACDIS speaker, Sarah Mendiola, Esq., LPN, CPC, tomorrow afternoon Wednesday, May 25, at 3:15 p.m., in Track 3, for her session, “Completing the Circle: The Importance of CDI Specialist Participation in the Denial Management Process.” We spoke with her about her experiences appealing claims that have been denied by CMS contractors, and what she hopes to bring to this year’s event.

Q: Tell me a little bit about why CDI specialists should get involved in the denial management process.

A: CDI specialists need to understand what denials their organizations receive, so they can implement appropriate safeguards on the front end to prevent them from reoccurring. Since the CDI team has the opportunity to review the documentation, typically before the claim is even billed, they have the opportunity to implement changes in real-time practice to prevent future denials.

Q: What are three things attendees can expect from your session?

A: (Two) Midnights, Medicare, and Me! We will focus quite a bit on the 2-midnight rule. There was a lot of interest in the application of the rule when I presented at the conference last year, so I kept the format very similar to what we talked about then, and made this more of an updated presentation. Most of the presentation is focused on Medicare rules and documentation requirements, so we will talk about best practices for prevention, and opportunities for appeal if all else fails.

Q: Who should attend your presentation and why?

A: CDI specialists, physicians, nurses, and anyone else involved in chart review and/or patient status determinations.

Q: What do you think is the most important quality for a CDI professional to have?

A: There are so many! It really depends on the role of the CDI department in that facility. However, I think that it is most important for CDI professionals to be detail oriented and good educators. It is important to know your audience, to understand your physicians and practitioners, and be able to convey information in a way that is well received and will lead to practice changes when needed.

Q: What are you most looking forward to about this year’s conference? What is your favorite part of the conference?

A: I’m excited to be presenting! I always look forward to the educational sessions as well. The conference had so many great speakers last year and such a wide variety of topics—there is something of interest in each breakout time slot.