It used to come annually. Every October, compliance officers across the country would delve into its pages to determine what the Office of the Inspector General (OIG) planned to investigate for the coming calendar year—and what their facility’s risk level might be.
Almost half of hospitals in the United States will be getting lower payments for Medicare patients due to their readmission history, according to an analysis reported in Kaiser Health News...Read More »
Earlier this summer, CMS resumed Medicare fee-for-service audits which had been suspended starting the end of March because of the COVID-19 public health emergency (PHE).Read More »
Q: Have any other institutions had frequent clinical validation denials regarding acute pulmonary insufficiency following surgery? If so, what clinical indicators and resources do you use to appeal the denials?Read More »
Q: How do you measure productivity for a denials specialist? Do you measure the number of appeals per day, per week, or per month? Are there any other tasks that affect this metric?Read More »
Q: Our system is seeing increasing cases being denied inpatient care with the suggestion that the cases should have been billed as observation. Right now, our coding department handles the coding-based denials, CDI handles clinical validation denials, and care management...Read More »
As part of the 10th annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Lori Dellinger, BSN, RN, CCRN-K, CCDS, a CDI specialist at WellSpan Health Summit in Chambersburg, Pennsylvania, a member of...Read More »