Documentation improvement efforts related to denials management and audit prevention feel a lot like a trip through Alice’s looking glass, too. The list of auditing agencies alone can make CDI specialists feel like they’ve fallen into an alternative universe:...Read More »
By Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM-RN
The old adage, “the best defense is a good offense,” comes to mind when I think about the role of CDI in audit defense. Our job is to improve documentation. A number of positive outcomes result from clinical documentation work...Read More »
Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Appeal writing, like most things in a hospital, is a learned skill. Keeping things simple, both in terms of the arguments constructed and the language used in the letters themselves, will prevent you from creating horrific monstrosities...Read More »
No matter how thorough the documentation, no matter how precise the coding, denials still haunt the halls of most facilities. While many facilities have a denials department handling all appeals, others incorporate physician advisors and CDI professionals into the equation. Differing...Read More »
By Janie L. Brown, RN
Denied. It’s a word that no one wants to hear in any context. In healthcare, it’s a heavily weighted word. It means that, in spite of our best efforts to provide excellent care to our patients and to document that care appropriately, we are not receiving...Read More »
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 »
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 »
