Member Insight: CDI professionals key to the clinical validation denials process

by Shirlivia M. Parker, MHA, RHIA, CDIP, BS-HIM

There have been a multitude of discussions in the CDI profession about denials, specifically clinical validations for the past several years. The question that one may ponder is why CDI isn’t leading the way of clinical validation denials. The answer to that may be understanding how we can fit in, who we should talk to, why we aren’t invited to participate. I think the answer to that question is understanding how clinical validation denials, work, and understanding that not everyone in the revenue cycle may know that these types of denials exist. This article will help you identify:

1. Why the revenue cycle, specifically, the patient financial services (PFS) team may not know about these types of denials.
2. How to establish yourself, as a CDI professional or unit in the process, lead the way to process improvement, and become that extension with PFS to win the race on clinical validation denials.
3. Establish a tracking system to involve contracting and fight against strategies of the payers to take back money received, and your organization deserves.
4. Understand the type of denials to help understand the overall process of establishing a denial program. We all need to be on the same page in understanding different types of denials.