by James P. Fee, MD, CCS, CCDS, AHIMA-approved ICD-10-CM/PCS trainer
CDI physician advisors use their clinical experience linked to evidence-based medicine and their ability to engage colleagues to mitigate risk, especially where clinical validity is questioned, a situation...Read More »
Denial management is traditionally focused on improving hospital revenue cycle and financial performance. Appropriate routing and handling of denials from third-party payers improves net revenue and cash flow, and reduces rework.Read More »
Whether it be medical necessity, clinical validation, or coding-related—denials seem always on the rise. And those involved in denials management and appeals know how far reaching the...Read More »
Although managing accurate principal diagnoses and CC/MCC assignment is always going to be a focus for CDI professionals and coders (along with clarifying general documentation inconsistencies). Clinical validation denials are on the rise, making record...Read More »
Be aware of payer’s “home cooked” clinical criteria which are often not only outdated, but also ridiculous. Contrary to what the payer may claim, a patient does not regularly have to be at a near death state before having achieved grounds...Read More »
Generally speaking, developing consistent query policies and procedures for both coding and CDI staff helps keep everyone in compliance with coding regulations. Similarly, work with clinicians, CDI specialists, and coders as often as...Read More »
