Denials and appeals

Analyze how coding impacts preregistration, scheduling, coverage approvals, case management, and other revenue cycle functions.

CMS issued a final rule last month that spells out a new appeals process for patients initially admitted as inpatients but later reassigned to outpatients receiving observation services.

CDI staff must be able familiarize themselves with missing clinical indicators that commonly lead to denials.

Review education strategies for CDI professionals to improve documentation, reduce denials, and boost accuracy in medical records.

Analyze current denials trends to get a better understanding of your organization and potentially identify unknown issues.

Review up-to-date prevention and management strategies for three common types of denials.

Get back to the basics of sepsis documentation to combat the increasing rate of denials.

Use these tips to train your team on the latest definitions and coding guidance for diabetes screening and related services during your next training session. 

Ensure your queries are solid enough to protect your organization against denials.

Make sure staff who handle audit requests understand when a missing signature should — or should not — trigger an automatic denial of your claims or prior authorization requests. Recent guidance from CMS clarifies how auditors should proceed when a medical record lacks a signature.