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—whether that means weighing in on a case-by-...Read More »
For CDI professionals working on denials management or appeals in any capacity, the payer side of the equation can often seem mystifying. Recently, ACDIS spoke with a coding professional working for a major private payer organization about her desire to sit for the new Certified Clinical...Read More »
According to the 2019 CDI Week Industry Survey, 27.77% of respondents who are currently involved in the denials management/ appeals process work directly by writing appeal letters.
Particularly with the increased focus on clinical validation denials, more and more CDI professionals are...Read More »
On February 23, 2016, the Journal of the American Medical Association published new clinical definitions for sepsis and septic shock, dubbed “Sepsis-3.” In the three years since then, a host of analyses and conflicting documentation and coding requirements have caused not only consternation but...Read More »
by Sarah Nehring, CCS, CCDS
The last thing a query writer wants is to provoke a defensive response, but in the current healthcare environment, with denials on the rise, CDI specialists, as well as clinical and coding staff need to think defensively. Here are five things to...Read More »
by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Recovery Auditor (RA) denials raise my blood pressure more than anything else (except maybe the postal service and the IRS). The constantly increasing number of clinical validation denials are repeated attacks against my hospital and...Read More »
by William E. Haik, MD, FCCP, CDIP
Complex pneumonias such as Gram-negative bacterial pneumonias and aspiration pneumonias segregate to a higher-weighted MS-DRG (MS-DRGs 177–179 [Respiratory Infections and Inflammations]) than simple pneumonias such as Streptococcus pneumoniae...Read More »
by Cheryl Ericson, RN, MS, CCDS, CDIP and Cathy Farraher, RN, MBA, CCM, CCDS
From the outset, crafting appeals for clinical validation should follow the format established by the facility denials management team for any other appeal. Best practice for the opening paragraph is to...Read More »
