Higher overturn rates noted when the appeal is filed outside of the payer’s internal appeal process.  I’d like to share some information gained from appealing over 2,000 clinical validation denials for sepsis in the state of New York since the time of the release of the Sepsis-3 criteria in February…
Clinical validation denials continue to climb. When payers issue clinical validation denials, they challenge diagnoses documented in the chart by the providers caring for the patient. Sometimes, it’s not simply the validity of diagnoses in question, but whether coding rules were violated.  This being the case, assessment and subsequent potential…
Trends in Clinical Documentation, Past, Present, and Future – Part II EDITOR’S NOTE: This topic has solicited many comments, creating as contentious debate, since Part I was published in the ICD-10monitor e-News on July 17 and discussed the same day on Talk-Ten-Tuesdays. I want to highlight some of the comments,…
Trends in Clinical Documentation, Past, Present, and Future – Part I For nearly a century, since Grace W. Myers of Massachusetts General Hospital became the first medical records librarian in the early 1900s and the American College of Surgeons (ACOS) sought to improve the standards of medical records being created…
Document it right on the front end; avoid fighting a denial on the back end I was recently asked about a post from Hospital Performance regarding acute respiratory failure and airway protection (https://soundphysicians.com/blog/2018/06/20/from-the-appeals-desk-acute-respiratory-failure-part-1-2/), and I wanted to expand on what the author, Dr. Hesham Hassaballa, wrote. A key point is…
Medicare celebrated its birthday on July 30. It was 52 years ago, on the morning of July 30, 1965, that President Lyndon Johnson signed the four-inch-thick Medicare bill into law after it had undergone more than 500 amendments during its passage through the House and Senate. The bill was signed…