“Finally Friday!” Can CDI Specialists Offer More Help?

FRIDAY February 13, 2015:

The Game is Rigged:
Can CDI Specialists Offer More Help?

Getting Out in Front of Payor Mistakes

Watch the Replay and Get the Handouts

five aces dealt to CMS

CMS’ Hand. Almost every hand. Because we live in a world of “promulgated rules” written by bureaucrats. But can we get them to admit their mistakes? We discuss how to do that…

Another great thread began earlier this week on the rac-relief listserv, this time concerning some denials that have been appearing for toxic/metabolic encephalopathy. At least one payor, Humana, was issuing denials for 348.39, asserting that some specific exams were required to show medical necessity. Answers posted and discussion that followed suggested that, basically, Humana was making an error in judging the need for such specific testing, provided that the physician and other staff include even routine descriptions of the patient’s progress or lack of progress, from admission.

We want to discuss the scenario in question and use it to offer some possible solutions:

  • How to recognize what’s been “missing” (according to the payor audits)
  • How to respond to Payors‘ “mistaken” denials
  • How to do some internal “root cause” analyses
  • How to enlist CDI Specialists to help avoid these costly denials

Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI – Glenn has extensive experience in ICD-9 and CPT coding, focusing upon the role of medical record clinical documentation in the charge capture, reimbursement, quality and outcomes studies, and medical necessity establishment process.

To that end, we invited the Executive Director for the Foundation for Physician Documentation Integrity (FPDI), Glenn Krauss, to join our discussion, as well as tell us about this new entity, the FPDI.

Also joining our panel will be Dr. Ron Hirsch from Accretive Health, a long time contributor to rac-relief and a frequent panelist on our show.

Given the subject… we are bound to have a lively discussion…

 

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Handouts for This Week's Show

Included this week:

AHA RAC Update of Feb 5 2015
AHA Letter to HHS/OIG November 20 2014
OIG Response to AHA Letter Jan 15 2015
Two Testimony PDFs from House Committee Mtg Feb 11 2015
Report to AMA on Cost of ICD-10 Implementation for Physicians
SLIDES for Finally Friday! Show

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REPLAY of This Week's Show

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We Appreciate Our Sponsors for this show:

 Craneware  |  The Health Law Partners | Recovery Analytics

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