CDI Journal - Volume 11, Issue 6

Pass the PEPPER: Benchmark CDI efforts and defend against denials

November 1, 2017
ACDIS Guidance, Quality & Regulatory, Denials & Appeals

No, we don’t mean the common table spice. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is distributed by TMF Health Quality Institute under contract with CMS and summarizes facility-specific data statistics for Medicare services that may be at risk for improper payments...Read More »
CDI Journal - Volume 11, Issue 5

Download the September/October 2017 edition of the CDI Journal

September 1, 2017
ACDIS Guidance, Denials & Appeals, Quality & Regulatory

FEATURES

8 The denials landscape: Physicians’ perspectives

14 CDI specialists see an inside scoop on denials management

25 Sure-up your risk and severity through morality reviewsRead More »
CDI Journal - Volume 11, Issue 5

Associate Editorial Director's Note: Documentation through the denials looking glass

September 1, 2017
ACDIS Guidance, Policies & Procedures, Denials & Appeals

by Melissa Varnavas

Documentation improvement efforts related to denials management and audit prevention feel a lot like a trip through Alice’s looking glass, too. The list of auditing agencies alone can make CDI specialists feel like they’ve fallen into an alternative universe:...Read More »
CDI Journal - Volume 11, Issue 5

Note from the Advisory Board: 'The best defense:' How documentation capture helps with denials management

September 1, 2017
ACDIS Guidance, CDI Expansion, Denials & Appeals

By Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM-RN
The old adage, “the best defense is a good offense,” comes to mind when I think about the role of CDI in audit defense. Our job is to improve documentation. A number of positive outcomes result from clinical documentation work...Read More »
CDI Journal - Volume 11, Issue 5

Book Excerpt: Appeal writing gets easier with practice

September 1, 2017
ACDIS Guidance, CDI Expansion, Denials & Appeals

Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Appeal writing, like most things in a hospital, is a learned skill. Keeping things simple, both in terms of the arguments constructed and the language used in the letters themselves, will prevent you from creating horrific monstrosities...Read More »
CDI Journal - Volume 11, Issue 5

The denials landscape: Physicians' perspectives

September 1, 2017
ACDIS Guidance, Physician Queries, Denials & Appeals

No matter how thorough the documentation, no matter how precise the coding, denials still haunt the halls of most facilities. While many facilities have a denials department handling all appeals, others incorporate physician advisors and CDI professionals into the equation. Differing...Read More »
CDI Journal - Volume 11, Issue 5

Extending CDI’s reach: Denials management

September 1, 2017
ACDIS Guidance, CDI Expansion, Denials & Appeals

By Janie L. Brown, RN
Denied. It’s a word that no one wants to hear in any context. In healthcare, it’s a heavily weighted word. It means that, in spite of our best efforts to provide excellent care to our patients and to document that care appropriately, we are not receiving...Read More »
CDI Journal - Volume 11, Issue 5

CDI staff see inside denials management

September 1, 2017
ACDIS Guidance, CDI Expansion, Denials & Appeals

Because of payers’ propensity for denials, facilities need to have a process in place for managing denials’ root causes on the front end and appealing them on the back end. This, however, can involve a lot of hard work and headaches.

Enter the denials management team.Read More »

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