Every year, organizations receive more denials, and payers’ tactics are shifting based on coding rules, clinical criteria, and their own whims.
As a result, many CDI teams find themselves involved with the denials management and appeals process—whether that means weighing in on a case-by-...Read More »
For CDI professionals working on denials management or appeals in any capacity, the payer side of the equation can often seem mystifying. Recently, ACDIS spoke with a coding professional working for a major private payer organization about her desire to sit for the new Certified Clinical...Read More »
According to the 2019 CDI Week Industry Survey, 27.77% of respondents who are currently involved in the denials management/ appeals process work directly by writing appeal letters.
Particularly with the increased focus on clinical validation denials, more and more CDI professionals are...Read More »
By Candace Blankenship, BSN, RN, CCDS
The role of the CDI specialist is in constant flux. When I started out as a CDI specialist, my hospital wanted me to focus on reimbursement. Having one focus gave me a clear path and little conflict when I was educating and querying providers...Read More »
On February 23, 2016, the Journal of the American Medical Association published new clinical definitions for sepsis and septic shock, dubbed “Sepsis-3.” In the three years since then, a host of analyses and conflicting documentation and coding requirements have caused not only consternation but...Read More »
by Rachelle Musselman, BSN, RN, Jorde Spitler, BSN, RN, Daniel Lantis, BSN, RN, Joseph E. Ross, MD, and Thomas A. Taghon, DO, MHA
When a condition is ill defined and documented by a provider, it renders the CDI specialist, and later the coding professional, unable to capture the...Read More »
Q: We recently had a patient who was admitted with sepsis and the physician documented sepsis, a urinary tract infection (UTI) related to chronic Foley catheter, and pneumonia. Can we code sepsis first instead of the complication code? Or is the complication always first? ...Read More »
CDI Week 2019 kicks off in just 16 short days and will run September 16-20. This year’s theme is “CDI Superheroes: The Heroes Hospitals Deserve,” celebrating CDI professionals’ wide range of skill sets that extend over a variety of areas, their influence making its way into all aspects of...Read More »