The process of denials and appeals is often referred to as a form of "word game" with players crafting persuasive arguments using specific language to present and counter claims. It’s important to recognize, however, that the stakes are
CDI departments have long been involved with the denials management process at this point, most frequently helping with clinical validation and DRG downgrade denials as those seemed to naturally fit into CDI’s regular preview. Medical necessity denials—i.e.,...Read More »
When I became a CDI specialist, I did not foresee myself being someone who would be writing clinical validation appeals. Historically, as a utilization review case manager, I generated medical necessity denials based on my chart review...Read More »
Presenting your authentic self is a key factor in reaching personal and organizational success. In CDI, we have great opportunities to promote authenticity on our teams. The ability to present your authentic and genuine self has many benefits,...Read More »
Clinical validation denials are those in which a payer denies a claim based on the grounds that the coded diagnosis (or diagnoses) did not meet the clinical criteria for that condition. CDI professionals involved in appealing these denials often complain that...Read More »
