According to an Office of Inspector General (OIG) audit, CMS did not use Comprehensive Error Rate Testing (CERT) data to identify waste or fraud. The audit states that previous OIG reports “recommend using CERT data to identify...Read More »
by Linnea Archibald
Winter is a time for hunkering down, a time to reflect as the year winds down and prepare as the new one approaches. November and December tend to be filled with a quiet sort of busyness, the kind of busyness that looks like lingering around a holiday dinner...Read More »
by Carolyn Riel
The inpatient prospective payment system (IPPS) was first implemented in 1983 to help combat unnecessary or excessive services being charged when Medicare was reimbursing on a fee-for-service model. Before the IPPS, the International Classification of Diseases (...Read More »
by Leyna Belcher, MSN, RN, CCDS, CCDS-O
According to Margaret Thatcher, “You may have to fight a battle more than once to win it.” In healthcare, the ultimate ongoing battle is fighting denials. These denials have become a battleground as payers lack oversight and are inconsistent...Read More »
by Carolyn Riel
CDI programs can take many approaches to manage denials, whether they focus on physician documentation education, have a team member dedicated to writing appeals, or anything in between. For Kimberly Huff, COC, CCDS, clinical validation denials...Read More »
