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
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 »
