by Brian Simpson, MS, RRT, CCDS, CDIP, CCS, CRC
Despite not having a formal denials management team at Penn Highlands Healthcare, I am fortunate enough to assist our coding department when we receive a clinical validation denial. Since I am a respiratory therapist by background,...Read More »
by Howard Rodenberg, MD, MPH, CCDS
I'm writing this a few weeks before Halloween, but I'm already feeling haunted. The spirit in question is the ghost of the ACDIS conference, our annual springtime gathering in the city where everything that happens stays there as long as nobody...Read More »
by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Few things evoke such a visceral response from CDI professionals as the phrase “payer denial.” Organizations with which I am familiar deal with constantly increasing payer denial volumes and continually evolving denial strategies as...Read More »
Contributor’s note: Clinical validation is a major focus of CDI efforts. So, in continuing his exploration into CDI research and pulling forward experiences shared during various ACDIS poster presentations, Howard Rodenberg, MD, MPH, CCDS, reached out to his colleague Audrey...Read More »
by Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC
The Official Guidelines for Coding and Reporting Section I.A.19 titled “Code assignment and Clinical Criteria” says the following:
The assignment of a diagnosis code is based on the provider...Read More »
In 2017, nearly 38% of CDI professionals said they review medical records primarily for financial outcomes, according to an ACDIS benchmarking survey. ACDIS sources sounded alarm bells saying:
CMS reported that it plans to begin audits that would include chart reviews for validity of diagnoses in 2020 after a recent study by the Office of Inspector General (OIG). The study found potential issues with the extent to which chart reviews are leveraged by Medicare Advantage Organizations...Read More »
