Because of payers’ propensity for denials, facilities need to have a process in place for managing denials’ root causes on the front end and appealing them on the back end. This, however, can involve a lot of hard work and headaches.
Last week I had the wonderful opportunity to attend the joint Tennessee Health Information Management Association/Tennessee ACDIS local chapter meeting. The Tennessee Hospital Association kindly hosted the all-day event at their wonderful facility in Brentwood. The theme of the meeting was ...Read More »
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 »
By Cheryl Manchenton, RN, BSN
From a bird’s–eye view, your CDI program may be a well-oiled machine. CDI specialists pose queries, physicians respond, and coders assign the most accurate and specific codes. But, what happens as your organization continues its journey from volume-...Read More »
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 »
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 »
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 »