Some clinicians may interpret a query as an affront to their clinical judgment. This is not your intent. You are trying to determine whether a condition was present and whether it should compliantly be coded or not.
Auditors target multiple conditions which for clinical validation denials (CVD). Personally, I found acute kidney injury (AKI) and malnutrition the most commonly defensible targets. On the other hand, I often agreed with auditors on their CVDs...Read More »
Clinical validation denials (CVD) result from a review by a clinician, such as a registered nurse, contractor medical director, or therapist, who concludes, retrospectively, that a patient was not really afflicted by a condition documented in...Read More »
by Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS
The coding function would not exist if there were no physician documentation from which to code. The challenge for coders is not so much that there is no physician documentation; it’s that the documentation they have does not...Read More »
While many facilities have developed robust denial management teams and have implemented comprehensive procedures for submitting appeals, one of the more powerful strategies in reducing denials can be summed up with this well-known expression: Nip it in the bud.
