WEBINAR: Clinical Documentation Improvement: Increasing


Clinical Documentation Improvement: Increasing Revenue While Reducing Denials & Appeals

OVERVIEW:
Are coding denials by insurers such as Humana, Aetna and Blue Cross now taking up your time or the time of your denials management staff? Clinical validation denials are widespread and intrusive. Many of the targeted diagnoses have been documented clearly and consistently in the medical record but do not meet accepted published clinical indicators.

 Official coding advice directs coders to code diagnoses that are documented by a physician as long as there is no conflicting documentation. Is the fact that the clinical “information” contained in the record does not “confirm” the diagnoses documented by the provider enough to remove the code(s) from the claim and pay the claim under a different DRG? The presenters have reviewed and appealed hundreds of such denials, and they will discuss the diagnoses receiving the most denials and clinical criteria used to make the denial. In addition, they will share their findings, successful appeals and those that were unsuccessful and why.
Concurrent clinical validation of the principal diagnosis, and CC/MCCs that determine the MS-DRG by CDI is necessary to ensure the documentation in the medical record supports the codes assigned, thereby preventing future clinical validation denials. Learn how to compose physician queries that will obtain the clinical indicators to support or rule out a diagnosis that is not appropriate.

OBJECTIVES:
• Understand difference between DRG validation and Clinical validation;
• Understand evidence-based clinical practice guidelines and how third-party payers are using them to generate coding and/or DRG changes;
• Describe basic content of appeal letters and timely submission requirements;
• Develop internal tracking mechanisms to identify coding/DRG change denials and appeals; and
• Discuss sample issues/cases involving coding/DRG changes due to clinical validation and/or documentation issues.

WHO SHOULD PARTICIPATE:
Hospital clinical coding specialists, documentation improvement specialists, coding managers, compliance officers and HIM managers.

MEET YOUR FACULITY:
Barbara Flynn, RHIA, CCS, is the Vice President of Code & Comply Specialists, a nationwide HIM consulting and compliance consulting firm offering clinical coding services, coding compliance and documentation audits, CDI education and HIM management. Code & Comply Specialists is a subsidiary of the Florida Hospital Association Management Corporation and has been providing these services for more than 25 years. Barbara has been an AHIMA-approved ICD-10-CM/PCS Trainer and Ambassador and is widely recognized as a coding and compliance expert. She has provided numerous seminars for FHIMA and other organizations on coding and billing compliance, ICD-10 implementation strategies, appropriate physician queries, regulatory compliance and many other topics during her 40+ year career in HIM.

Silvia G. Ortiz, MSHSA, RHIT, CMPSM, is a Senior HIM Consultant/Coding QA Auditor for Code & Comply Specialists with more than 35 years of experience in the health information and medical staff management fields with extensive knowledge in ICD-10-CM/PCS clinical coding compliance, auditing and appeals management. She is an AHIMA-Approved ICD-10 CM/PCS Trainer and holds a master’s degree in Health Services Administration. She is currently a member of AHIMA, FHIMA and NAMSS, and she serves on the Keiser University’s Health Information Management Program Advisory Board.
 
When
10/24/2018 - 10/24/2018
Where
Webinar
United States

Program


Wednesday, 24 October 2018

 
Time
9:30 AM - 11:00 AM
10/24/2018 9:30 AM
Time
9:30 AM - 11:00 AM
10/24/2018 9:30 AM
Time
9:30 AM - 11:00 AM
10/24/2018 9:30 AM
Time
9:30 AM - 11:00 AM
10/24/2018 9:30 AM

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