Q:We’ve encountered audit takebacks and denials from a certain payer who removed codes and procedures that result in lower DRGs. Do you have any advice for fighting or preventing these types of denials?Read More »
Medicare incorrectly paid approximately $1.7 million to Carolinas Medical Center in Charlotte, North Carolina, as a result of incorrect billing on the part of the medical center.Read More »
by Allen Frady, RN-BSN, CCDS, CCS, CRC
More than a decade ago, I received a claim from patient financial services with a denial due to an “incorrect code.” The patient was pre-certified through the insurance company for a femoral popliteal bypass graft. We correctly coded the...Read More »
by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Like it or not, provider documentation is the foundation for everything done in medicine. Without it, nothing is accomplished. As healthcare reform progresses (and hospital reimbursement shrinks), the need for excellent provider...Read More »
People are human. This goes for clinicians, coders, and for CDI personnel. Mistakes happen. If left unchecked, however, mistakes become habits. Effective CDI programs understand this and take appropriate steps to ensure occasional...Read More »
“DRG validation can mean many things in many different arenas,” Autumn Reiter, RN, BSN, CCDS, CDIP, CCS, director of CDI staffing services at TrustHCS, said on the January 3 episode of ACDIS Radio, “New approaches in DRG validation.” “Essentially, it’s ensuring a correct final...Read More »
