When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.
Guest speaker:
Erica Braun, MS, RN, CCDS
Consulting ...
When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.
Guest speaker:
Erica Braun, MS, RN, CCDS
Consulting Director
Vizient
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
Show Notes:
[01:11] Clinical validation denial
[01:31] Implications for denials: downgraded DRGs and lower reimbursement
[02:31] Avoiding denials
[03:25] When diagnoses are at high risk for denial
[03:59] Examples of disputed diagnoses
[04:30] Establishing criteria for diagnoses
[05:15] What physicians can do to help improve documentation
[06:17] What to do when a denial occurs
[07:29] Negotiating and coordinating with payers
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Erica Braun’s contact email: erica.braun@vizientinc.com
Fact sheet on Vizient’s clinical documentation improvement services: Click here
Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here
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