Insurance claim denials and DRG downgrades are frequent concerns and growing areas of focus for CDI programs. CDI functions have expanded to include denial mitigation in their record review process, seeking to capture patient complexity, clarify documentation inconsistencies, and clinically...Read More »
According to a recent KFF analysis, healthcare organizations are submitting more prior authorization requests to Medicare Advantage (MA) plans than they...Read More »
The full agenda is now available for the 2024 Revenue Integrity Symposium (RIS), held by the National Association of Healthcare Revenue Integrity (NAHRI)! This year, their third track has been dedicated fully to denials...Read More »
Q: According to one of our private carriers, we should report bilateral services with modifier -50 (bilateral procedure) for physician claims in one of the following ways:
Report modifier -50 on two service lines with 1 unit each
Not all CDI departments are directly involved in denials management. However, every CDI specialist plays a vital role in denials management through concurrent chart reviews and collaboration with healthcare providers. Sepsis, acute...Read More »
Healthcare organizations are positively affected when CDI is directly involved in the justification of medical necessity, reimbursement claims, and the improvement of patient outcomes. When clinical documentation practices are not held to...Read More »
