The ACDIS Forms & Tools Committee works to review materials donated to the ACDIS community for publication in the Forms & Tools Library for accuracy, compliance, relevance, and effectiveness.
Recently, we’ve seen an uptick in clinical validation denials regarding acute pulmonary insufficiency and acute respiratory failure following surgery. What can we do to fight or prevent denials for these diagnoses?Read More »
The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and...Read More »
Are institutions appealing sepsis denials if the patient meets sepsis-2/super systemic inflammatory response syndrome (SIRS) criteria, but not sequential organ failure assessment (SOFA) criteria? We have one hospital in our system that uses only sepsis-2 as their criteria, and many of them have...Read More »
A Humana health plan in Florida overcharged Medicare by nearly $200 million in 2015 by incorrectly billing for high severity hierarchical condition categories (HCC) that were not supported, according to...Read More »
I was wondering if anyone had experience with denials from commercial payers that goes beyond the third level of appeals. We are getting response letters that state “completion of a level 3 dispute exhausts internal administrative rights.” What are other hospital systems doing with this response...Read More »
Sunrise Hospital & Medical Center in Winchester, Nevada, submitted Medicare claims for rehabilitative services that did not comply with Medicare billing requirements,...Read More »
