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 »
By Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS
The 2017 Official Guidelines for Coding and Reporting, effective October 1, 2016, contained a new, perplexing, and problematic section I.A.19 titled “Code Assignment and Clinical Criteria,” which states:...Read More »
Q: What guidance do you have for building a denial management team?
A: As with any team, it is important to have the right players working together with identified roles and responsibilities established for each. The members of the denials management team...Read More »
