Denials & Appeals

The improper payment rate for hospital outpatient services for the 2016 CERT report period was 5.4%, at a projected cost of $3.1 billion, which...Read More »

Part 3 (to read part 1, ...Read More »

No matter how diligent the CDI team, payers will still issue claims denials. Because of this well-known fact, the...Read More »

By Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM-RN
The old adage, “the best defense is a good offense,” comes to mind when I think...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....Read More »

by Melissa Varnavas

Documentation improvement efforts related to denials management and audit prevention feel a lot like a trip...Read More »

No matter how thorough the documentation, no matter how precise the coding, denials still haunt the halls of most facilities. While many...Read More »

By Janie L. Brown, RN
Denied. It’s a word that no one wants to hear in any context. In healthcare, it’s a heavily weighted word. It...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)...Read More »

FEATURES

8 The denials landscape: Physicians’ perspectives

14 CDI specialists see an inside scoop on denials...Read More »