News: CMS could use extrapolation to determine MA paybacks

August 29, 2019
CDI Strategies - Volume 13, Issue 36
Denials & Appeals, News, Quality & Regulatory

CMS proposes to extrapolate results from Medicare Advantage (MA) audits and apply an overall error rate for all plans, according to...Read More »

Sample level 2 appeal letter

August 20, 2019
Policies & Procedures
Denials & Appeals, Policies & Procedures

This sample level 2 appeal letter was provided by Jera Van Damme, BSN, RN, CCDS, senior clinical documentation educator at Essentia Health in Duluth, Minnesota.

This sample was examined and approved by the Resource Library Committee in 2023. The committee recommends that, if a program...

Sample appeal letter

August 20, 2019
Policies & Procedures
Denials & Appeals, Policies & Procedures

This sample appeal letter was provided by Jera Van Damme, BSN, RN, CCDS, senior clinical documentation educator at Essentia Health in Duluth, Minnesota.

This sample was examined and approved by the Resource Library Committee in 2023. The committee recommends that, if a program uses this...

News: Baylor wins $61.8 million FCA case over alleged upcoding

August 15, 2019
CDI Strategies - Volume 13, Issue 34
Clinical & Coding, Denials & Appeals, News

Providence Health & Services wasn’t the only one under fire from Integra Med Analytics. The firm also filed a suit alleging that Baylor Scott...Read More »

Note from the ACDIS Editor: Denials management life rafts for murky waters

August 1, 2019
CDI Strategies - Volume 13, Issue 32
ACDIS Guidance, CDI Expansion, Denials & Appeals

By Linnea Archibald

More than half of all respondents to the 2019 CDI Week Industry...Read More »

News: HHS ahead of schedule in court-ordered appeals backlog reduction

August 1, 2019
CDI Strategies - Volume 13, Issue 32
News, Denials & Appeals

As of July 1, HHS has reduced the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by nearly 20%, according to...Read More »

Q&A: Sepsis criteria conundrum

July 30, 2019
CDI Blog - Volume 12, Issue 106
Ask ACDIS, Clinical & Coding, Denials & Appeals

Q: Which sepsis criteria should we use? It seems like we get denials quoting every criteria set and...Read More »

Summer reading: Tools of the denials steering committee’s trade

July 12, 2019
CDI Blog - Volume 12, Issue 99
ACDIS Guidance, CDI Expansion, Denials & Appeals

by Chris Simons, MS, RHIA

Facilities looking to establish or improve their denials management program should consider implementing...Read More »

News: Poor documentation training cited as one reason for possible hospital closure

July 11, 2019
CDI Strategies - Volume 13, Issue 29
News, Education, Denials & Appeals

Citing severe financial difficulties, Hahnemann University Hospital in Philadelphia will close its doors in early September of this year with...Read More »

Note from the Associate Editorial Director: Coding from the discharge summary

June 13, 2019
CDI Strategies - Volume 13, Issue 26
ACDIS Guidance, Clinical & Coding, Physician Queries, Denials & Appeals

By Melissa Varnavas

I recently received an email from ACDIS friend, and Chapter Advisory Board member, Molly Seibert on behalf of...Read More »

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