Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Appeal writing, like most things in a hospital, is a learned skill. Keeping things simple, both in terms of the arguments constructed and the language used in the letters themselves, will prevent you from creating horrific monstrosities...Read More »
No matter how thorough the documentation, no matter how precise the coding, denials still haunt the halls of most facilities. While many facilities have a denials department handling all appeals, others incorporate physician advisors and CDI professionals into the equation. Differing...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 means that, in spite of our best efforts to provide excellent care to our patients and to document that care appropriately, we are not receiving...Read More »
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.
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 »