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 »
by James S. Kennedy, MD, CCS, CDIP
Over the years there’s been a tsunami of denials from payers, Recovery Audit Contractors (RAC), and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can...Read More »
By Sharme Brodie, RN, CCDS
Another issue of AHA’s Coding Clinic is out, and much of the information in the newest release pertains to the coding of interventions or procedures. There are, however, a few questions and answers found in Coding Clinic, Third Quarter 2017,...Read More »
