EDITOR’S NOTE: Edward Hu, MD, CHCQM-PHYADV, a past president of the American College of Physician Advisors, also contributed to this article. Dr. Hu and Dr. Banker both participated in a series of meetings with Centers for Medicare & Medicaid Services (CMS) officials, with the end result being the recently issued…
EDITOR’S NOTE: Lisa Banker, MD contributed to the following report.Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers for…
CDI can drive down adversarial determinations of medical necessity and costly denials.  In my article published last week, titled Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement (CDI), I outlined that CDI plays a major role indeed in the context of overall healthcare…