Note from the Associate Editor: Take a sneak peek into the industry’s denial mitigation trends

by Jess Fluegel

Not all CDI teams are directly involved in the denials management or appeals process, but every CDI professional knows the value of avoiding a denial in the first place. CDI departments employ many methods, often concurrently, to target different issues related to their organization’s denial trends. Though I’m still learning every day, my continuing education on the complex world of CDI has taught me how frustrating of a problem payer denials can be.

So, with our 2022 CDI Week Industry Survey now closed, I had the chance to preview some of the findings and wanted to share a teaser on this particular subject! Given all the work that goes into CDI, it makes sense that denial mitigation is a hot topic—who wants to have all their hard work undone? But knowing the most popular methods can provide insight into what your department could start doing or do a little differently to help with denials management.

Of the 13 options given in the survey, respondents could select any denial mitigation method that applied to them or their program, and we received a wide array of answers across the board. Though there is clearly not a one-size-fits-all solution, the most-selected methods do indicate a trend of what is and isn’t working. With that in mind, here are the top five from our survey results:

• 47%: We clinically validate high-risk diagnoses concurrently (e.g., malnutrition, sepsis, etc.)
• 39%: We review denials on a case-by-case basis upon request
• 31%: We conduct mortality reviews for denial defense
• 30%: We provide education to physicians based on denial trends
• 23%: We help to write the appeal letters

The survey question also included an ‘other’ category with a free response option, and though there were not many who chose this section (about 11%), I still found their answers quite interesting. Most respondents in this category said they were unsure or simply uninvolved in the process, but some specified that it was handled by someone else, like their CDI leader, a specially assigned CDI professional or sub-team, a third-party vendor, or an entirely separate department. Given last year’s findings, it’s clear that more and more organizations are using CDI professionals to assist in some aspects of denial management—but in true CDI fashion, that looks different depending on each organization’s circumstances.

From just this single question there are so many important implications and possible insights to extract. Given that the survey has 46 industry questions that over 700 people have answered, ACDIS is thrilled to be releasing all the collected data during this year’s CDI Week festivities occurring September 12-16. We’d like to extend a warm thanks to all the respondents who contributed to this valuable resource and look forward to sharing more with you soon!

Editor’s note: Fluegel is an associate editor for ACDIS, which is based in Middleton, Massachusetts. Contact her at jfluegel@acdis.org. To read our 2020 CDI Journal edition all on CDI efforts in denials management, click here.