“Denied.” It’s a word no one wants to hear in response to their healthcare claims. Yet, it’s more frequently on the lips of both governmental and private payers. Whether it be clinical- or coding-related, denials are an ever-present reality in today’s healthcare environment, threatening the...Read More »
This new paper from Elsevier, defines the process of DRG validation and how it can benefit provider organizations by ensuring that the correct information is communicated the first time.Read More »
In a recent blog post, CMS Administrator Seema Verma highlighted progress in reducing provider complaints related to the Medicare RAC program and the associated backlog of...Read More »
A national survey of 118 CDI leaders, including supervisors, managers, and directors, reveals trends in clinical denials and the role of CDI professionals in their prevention and appeal.Read More »
Insufficient documentation led to approximately $23 billion in improper Medicare payments in FY 2017, the GAO said in a March 27 report. GAO recommended that CMS assess and strengthen documentation requirements and medical reviews to more...Read More »
FEATURES 9 CDI in a changing denials landscape 13 The payer side of CDI 15 Frontline appeal writing advice 20 Organization-wide clinical definitions...Read More »
by Irina Zusman, RHIA, CCS, CCDS
Both ccommercial and public payers now deny about one in every 10 submitted claims, costing health systems up to 2% of net patient revenue, according to a March 2019 article in Modern Healthcare. As the cost of healthcare continues to skyrocket,...Read More »
Every year, organizations receive more denials, and payers’ tactics are shifting based on coding rules, clinical criteria, and their own whims.
As a result, many CDI teams find themselves involved with the denials management and appeals process—whether that means weighing in on a case-by-...Read More »
