Q: Which sepsis criteria should we use? It seems like we get denials quoting every criteria set and are at a loss for how to prevent them or respond.Read More »
Facilities looking to establish or improve their denials management program should consider implementing a steering committee to set overarching priorities, review data, assess findings, and maintain communication channels between senior executives and...Read More »
William Ellex, RN, CCDS, will present a poster titled “The CDI role in the denial process: How the CDI and physician advisor can work together for a successful appeal process,” at the 2019 ACDIS conference. Ellex is a lead inpatient CDI specialist, HIM, at Reading Hospital Tower Health in...Read More »
The question often surfaces regarding what to do with CDI queries once they have been issued. My best advice is keep them. Most facilities do not consider concurrent queries part of the permanent medical record because physicians respond...Read More »
Q:We have a couple providers that will diagnose patients with severe sepsis with septic shock when they are hypotensive stating that they “caught the cascade early” and averted the need for vasopressors. Alternatively, the...Read More »
by Denise Wilson, RN, MS, RRT, and Karla Hiravi, RN, BSN
Facility appeal writers must craft piles of appeals, with virtually no time to investigate the accuracy of payer denials. However, understanding the appeal process is crucial.Read More »
By Trey La Charité, MD, FACP, SFHM, CCDS
Over the years, Congress passed numerous pieces of legislation to limit healthcare spending, combat losses due to fraud, and ensure that dollars spent truly benefit the American population with quality care. Numerous watchdog programs...Read More »
