Note from the ACDIS Editor: CDI Journal focuses on preventing, fighting denials

by Linnea Archibald

Typically, CDI specialists’ work happens before the bill drops, while the patient is in the hospital or immediately following discharge before final coding. Even with the most stringent CDI processes and an exceptionally engaged physician group, we know that that final bill will never be entirely safe from auditor scrutiny or secure from the risk of denial.

Payer denial tactics are getting more and more aggressive with each passing year, according to 2020 CDI Week Industry Survey respondents, putting organizations at great financial risk. A risk felt more keenly this year in light of slashed organizational budgets and revenue shortages associated with COVID-19. According to ACDIS’ May 2020 survey regarding COVID-19’s impact on CDI departments, more than 60% of respondents said their department has been affected by organizational cost saving measures such as staff furloughs, education budget cuts, unpaid time off, pay reductions, and even layoffs.

Within this landscape, against the backdrop of tenuous organization-wide bottom lines, an increasing number of CDI departments find themselves tasked with helping to avoid downstream denials or even pushing back the wave of existing denials through the appeals process. That’s why ACDIS devotes the entire November/December edition of the CDI Journal to CDI efforts in denials management.

Within this edition’s changes, you’ll find articles focused on:

• Departmental collaboration
• Clinical validation strategies
• CDI leaders’ perspective on denials management
• Denial volumes as key performance indicators
• Tactics for sepsis and malnutrition denials
• Insight on the top denied diagnoses
• Physician advisors’ roles in the denials management process

Plus, we have articles from Associate Editorial Director Melissa Varnavas on current denial trends, an overview of CDI research related to mortality reviews, a physician advisor’s take on clinical validation reviews and denials, a recap of a conversation with the Office of Inspector General on the ACDIS Podcast, and an interview with an ACDIS member in our regular Meet a Member column.

The ACDIS team hopes you enjoy this latest edition and that you’ll find some helpful information to fight denials and win appeals within its pages. The January/February edition of the CDI Journal will focus on diversity in CDI, so if you’d like to contribute, wish to share your CDI journey, or suggest an article idea, feel free to email us.

Editor’s note: Archibald is the editor for ACDIS. Contact her at larchibald@acdis.org.