Like a well-oiled machine, each component—or revenue cycle department—must function optimally to perform at its peak. Therefore, denial avoidance is a cross-functional, ongoing initiative. The departments with the most involvement are typically patient access, care management, patient financial...Read More »
by James P. Fee, MD, CCS, CCDS, AHIMA-approved ICD-10-CM/PCS trainer
CDI physician advisors use their clinical experience linked to evidence-based medicine and their ability to engage colleagues to mitigate risk, especially where clinical validity is questioned, a situation...Read More »
Denial management is traditionally focused on improving hospital revenue cycle and financial performance. Appropriate routing and handling of denials from third-party payers improves net revenue and cash flow, and reduces rework.Read More »
Whether it be medical necessity, clinical validation, or coding-related—denials seem always on the rise. And those involved in denials management and appeals know how far reaching the...Read More »
Although managing accurate principal diagnoses and CC/MCC assignment is always going to be a focus for CDI professionals and coders (along with clarifying general documentation inconsistencies). Clinical validation denials are on the rise, making record...Read More »
Be aware of payer’s “home cooked” clinical criteria which are often not only outdated, but also ridiculous. Contrary to what the payer may claim, a patient does not regularly have to be at a near death state before having achieved grounds...Read More »
