ACDIS Council Report: Clinical Validation and Denials Management

It seems that denials have only been increasing over the years. In the wake of the COVID-19 pandemic, healthcare organizations simply cannot afford to hemorrhage money to unwarranted and unfounded denials. This imperative creates a natural entry point for CDI programs to help stem the tide. CDI professionals are already working to improve documentation and ensure the record paints an accurate picture of the patient’s condition and care, making them particularly equipped to shore up documentation for denial prevention. Getting involved in the denials management and appeals process, however, can pose challenges for workflow and bandwidth.

The Association of Clinical Documentation Integrity Specialists (ACDIS) CDI Leadership Council asked several of its members to evaluate the results of a nationwide survey detailing the current state of CDI’s involvement with the denials management and appeals process, who on the team handles such efforts, staffing constraints, top queried and denied diagnoses, and technology for clinical validation efforts.

In this industry report, readers get a full inside look at the ways organizations approach denials management and clinical validation!