Proactive measures in claim denial management can recoup lost revenue. Unfortunately, the majority of healthcare organizations encounter claim denials on a regular basis, often, habitually. Though claim denials may be an unavoidable reality in the world of healthcare, ineffective claim denials ...

Birth weight is used by APR-DRGs and MS-DRGs, and it impacts the assigned group.   The topic of newborns is rarely addressed when we talk about coding or clinical documentation integrity. Birth weight, prematurity, extreme prematurity, and other significant problems are all conditions that impact ...

Sepsis is a clinical diagnosis, and clinicians should be permitted to make the diagnosis appropriately. When I step up onto my sepsis soapbox, people often refer to New York State and tell me how they are not allowed to accept Sepsis-3, pursuant to state regulation. Full disclosure: I hail from ...