Every year, organizations receive more denials, and payers’ tactics are shifting based on coding rules, clinical criteria, and their own whims. As a result, many CDI teams find themselves involved with the denials management and appeals process.Read More »
CMS proposes to extrapolate results from Medicare Advantage (MA) audits and apply an overall error rate for all plans, according to an article in FierceHealthcare...Read More »
Providence Health & Services wasn’t the only one under fire from Integra Med Analytics. The firm also filed a suit alleging that Baylor Scott & White, a large Texas-based health system, wrongly billed Medicare for more than $61.8 million over seven years through the practice of upcoding...Read More »
More than half of all respondents to the 2019 CDI Week Industry Survey (56.51%) say they’re currently involved in denials management at their organization. What’s more, more than half of those involved (65.97%) say they...Read More »
As of July 1, HHS has reduced the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by nearly 20%, according to a status report from HHS.Read More »
Citing severe financial difficulties, Hahnemann University Hospital in Philadelphia will close its doors in early September of this year with inpatient admissions ceasing in July, according to a FAQ...Read More »
I recently received an email from ACDIS friend, and Chapter Advisory Board member, Molly Seibert on behalf of her colleague Kelli Newcom regarding whether it’s okay to use a diagnosis noted on a query form for coding purposes if it’s not captured in the...Read More »
“Denied.” It’s a word no one wants to hear in response to their healthcare claims. Yet, it’s more frequently on the lips of both governmental and private payers. Whether it be clinical- or coding-related, denials are an ever-present reality in today’s healthcare environment, threatening the...Read More »
