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.
By Rachel Strom, RN
Yes, I’ll admit it, I used to be one of those people, I am a former Medicare Administrative Contractor (MAC) reviewer. Before finding a great fit in on a CDI dream team (or so I’d like to think we are), I worked as a Medical Review Examiner for a MAC contractor...Read More »
A patient comes into the hospital, so sick that there’s likely no coming back. The physicians do everything they can, but the patient expires. Anyone working in a hospital setting knows this scenario all too well.
But, look more closely at the documentation for that patient. In many cases...Read More »
Only 28% of CDI specialists are involved in the denials prevention and appeals process, according to a poll on the April 12, 2016, episode of ACDIS Radio, “The importance of CDI in denials management,” while 40% are...Read More »
by James S. Kennedy, MD, CCS, CDIP
Over the years there’s been a tsunami of denials from payers, Recovery Audit Contractors (RAC), and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can...Read More »
Where there are documentation holes, denials flood in.
“It’s just amazing how infrequently the doctor is even aware of the denial. If they don’t know they even had a patient who was denied, then he or she can’t fix the documentation in the future,” said Timothy Brundage, MD, CCDS...Read More »
Q: When looking at denials timelines, what information should be noted?
A: There are many critical time elements to capture during the denial appeals process. It is recommended that you add these to your denials database. If that is not possible, an...Read More »
