CDI Journal - Volume 11, Issue 5

Denials: Tips from a former MAC reviewer

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

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 »
CDI Journal - Volume 11, Issue 5

Shore-up risk and severity through mortality reviews

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

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 »
CDI Journal - Volume 11, Issue 5

Radio Recap: Less than 30% involved in denials management

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

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 »
CDI Journal - Volume 11, Issue 5

Physician Advisor Corner: Eight top denial focus areas for auditors

September 1, 2017
ACDIS Guidance, Clinical & Coding, Denials & Appeals

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 »
CDI Journal - Volume 11, Issue 4

Radio Recap: Denials and effective physician communication

July 1, 2017
ACDIS Guidance, Education, Denials & Appeals

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 »
CDI Blog - Volume 10, Issue 150

Q&A: Tracking denials

November 9, 2017
Ask ACDIS, Denials & Appeals, Quality & Regulatory

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 »
CDI Blog - Volume 10, Issue 144

UnitedHealth Group, Inc. vs. the United States of America: The case for CDI

October 18, 2017
ACDIS Guidance, Denials & Appeals, Quality & Regulatory

Part 3 (to read part 1, click here. To read part 2, ...Read More »
CDI Blog - Volume 10, Issue 120

Guest Post, Part 1: Where do we stand with clinical validation?

August 29, 2017
ACDIS Guidance, Physician Queries, Denials & Appeals

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 »

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