Note from the ACDIS Editor: Denials management life rafts for murky waters

By Linnea Archibald

More than half of all respondents to the 2019 CDI Week Industry Survey (56.51%) say they’re currently involved in denials management at their organization. What’s more, more than half of those involved (65.97%) say they’re directly involved through appeal writing, reviewing specific diagnoses for denial prevention, or sending post-discharge queries and/or conducting mortality reviews for denial defense.

When ACDIS conducted a poll on the same topic in July 2017, only 28% of respondents said they were directly a part of denials management.

While CDI professionals’ involvement in the denials and appeals process can be a boon to their organization, taking that first step can be daunting and can feel suspiciously like scope creep. Since it’s clear that CDI involvement is increasing, however, I wanted to spend some time this week pointing those venturing into murky waters toward life rafts available on the ACDIS website.

A cursory search of the ACDIS website for the term “denials management” will bring up eight pages of results; “appeals” brings up 13 pages of results. Whether you’re involved on a case-by-case basis or have a formal process in place, there are resources there to help you.

For those strictly involved in clinical validation denials (for example, 77.39% of CDI Week Survey respondents), there are materials from past ACDIS conferences that may be of service to you. For example, watch this free webinar version of Erica Remer, MD, FACEP, CCDS, and Kelly Skorepa, BSN, RN, CDIS’ standing-room-only 2018 conference session. 

Additionally, you can read all about the latest clinical validation trends in this report (published in partnership with 3M), or register for this three-hour-long on-demand webinar with Cheryl Ericson, MS, RN, CCDS, CDIP, and Cathy Farraher, RN, BSN, MBA, CCM, CCDS, or this 90-minute on-demand webinar with Haaris Ali, MD, CDIP.

For tips on the clinical side of clinical validation, take a look at this ACDIS Blog post on the common denial rationale for acute kidney injury and acute tubular necrosis, this article from the CDI Journal on validating acute congestive heart failure exacerbations, or this Q&A about choosing a sepsis criteria for denials prevention.

For those looking to begin their involvement with denials management or appeals, start by reading all about denials management team building, justifying a dedicated appeals specialist position, building an effective appeals process, and constructing an appeal letter.

Take a look through the September/October 2017 edition of the CDI Journal for ideas and tips on getting your feet wet. The edition includes articles on denial trends, appeal writing, tips from a former Medicare Administrative Contactor, and more.

The resources I listed are not exhaustive (in fact, they just begin to scratch the surface of the website). Whether or not you’re an ACDIS member, there are hundreds, if not thousands, more resources available to help you. Just start digging. Remember, if you get stuck, don’t hesitate to reach out. We’re happy to help.

Editor’s note: Archibald is the editor for ACDIS. If you’re already involved in denials management or appeals and would be willing to contribute to the fall edition of the CDI Journal, please reach out to Archibald. Contact her at larchibald@acdis.org.