2013 Conference, Track 2: Successful Strategies to Avoid RAC Denials and DRG Downgrades

May 31, 2013
Conference Materials
Denials & Appeals

Attached is the PowerPoint presentation “Successful Strategies to Avoid RAC Denials and DRG Downgrades”, by Adelaide M. La Rosa, RN, BSN, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador, project manager for quality operations...

Guest Post: Helping the physician and the hospital through proactive denials management

June 28, 2012
CDI Blog - Volume 5, Issue 27
ACDIS Update, Education, Denials & Appeals

by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS

CDI specialists can increase their value to their hospital and ensure a far...Read More »

Exploring records for medical necessity

June 25, 2012
CDI Blog - Volume 5, Issue 26
Quality & Regulatory, Denials & Appeals

While CDI and coding staff members are well versed in assigning a principal ­diagnosis, they are often less adept at incorporating the concept of...Read More »

Guest Post: The clash of clinical vs. coverage/payment concerns

April 18, 2012
CDI Blog - Volume 5, Issue 14
ACDIS Update, Education, Denials & Appeals

by Trey La Charité, MD

In the aggressive post-discharge auditing environment where I now find myself practicing medicine, I and my...Read More »

Guest Post: Examine guidelines for medical necessity documentation needs

April 17, 2012
CDI Blog - Volume 5, Issue 13
ACDIS Update, Denials & Appeals, Quality & Regulatory

by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS

Because most CMS local and national coverage determinations governing medical...Read More »

Guest Post: WWRD: What would the RAC do?

February 7, 2012
CDI Blog - Volume 5, Issue 5
ACDIS Update, Quality & Regulatory, Denials & Appeals

by Karen Newhouser

There has been much discussion based on what Recovery Audit Contractors (RAC) and other state and federal...Read More »

2011 Conference: Getting Down to the Nitty-Gritty with RAC, QIO, and Other Denials

April 13, 2011
Conference Materials
Denials & Appeals

Attached is the powerpoint presentation Getting Down to the Nitty-Gritty with RAC, QIO, and Other Denials by Margi Brown, RHIA, CCS, CCS-P, CPC, CCDS, Independent Consultant.
 

Q&A: Avoid “rule out” to ensure medical necessity

February 23, 2011
CDI Blog - Volume 4, Issue 9
Ask ACDIS, Policies & Procedures, Denials & Appeals

Q: I know that in an inpatient setting coders are allowed to use a suspected diagnosis when a definitive diagnosis cannot...Read More »

Prevent RAC denials: Improve excisional debridement documentation

February 1, 2011
CDI Blog - Volume 4, Issue 2
Denials & Appeals, Quality & Regulatory

by Trey La Charité, MD

Every institution reading this column has likely received its first recovery audit contractor (RAC)...Read More »

Guest Post: Reduce RAC Vulnerabilities with a Quality CDI Program

June 24, 2010
CDI Blog - Volume 3, Issue 11
ACDIS Update, Quality & Regulatory, Denials & Appeals

DRG (diagnosis-related groups) validation issues have been the main target of RAC (recovery audit coordinators) nationwide in recent months. When...Read More »

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