Escalation policy addendum added to new AHIMA/ACDIS query practice brief

Third-party regulatory agencies often question the clinical validity of a physician’s diagnosis. Most hospitals have had a Recovery Auditor deny a claim due to lack of documentation identifying supportive clinical indicators in the medical record. But until recently, CDI specialists and coders had little guidance about what to do in these instances.

The ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Process” released earlier this spring added “lack of clinical indicators” to its previous guidance of when to query.