Requiring Medicare Advantage (MA) organizations (MAO) to definitively identify payment denials on encounter records submitted for MA would enhance program oversight and help combat fraud, according to a new report submitted by the Office of Inspector General (OIG). Although most 2019 MA...Read More »
I first became aware of clinical validation denials 12 years ago. I had the great fortune of working alongside a very astute coder at the time. When the Medicare Recovery Audit Contractors began audits for clinical validation in 2011, she quickly...Read More »
FEATURES 6 Appeal writing 101 11 CDI-related denials, tracking, and tools for appeal 17 Case study: Medical necessity denials management 25 ...Read More »
While Dorothy worried about lions, tigers, and bears (oh my!), CDI professionals involved in the denials management process develop a sixth sense around certain diagnoses known to be at high risk of denial. While some courage, brains, and heart will get you...Read More »
Nowhere does work in the healthcare setting feel more like a courtroom than the denials arena. Hospitals and healthcare systems seek to provide the best quality of care to their patients, but that care can come grinding to a halt if an organization’s billing gets...Read More »
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
