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 »
How should we handle denied claims when the payer refuses payment under the billed status? Do we need to document that the status was changed only because the payer did not agree to any other options?Read More »
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services based on a sample of claims, according to an Office of Inspector General (OIG) audit report released November 26. The OIG estimates that, based on...Read More »
The American Hospital Association (AHA) and other hospital groups filed a lawsuit December 4 challenging CMS’ hospital price transparency final rule, Revenue Cycle Advisor reported. The final rule, released November 15 and effective January 1, 2021, expands on the price transparency...Read More »
