Description: Payer denials continue to significantly impact Hospital Revenue Cycle. Within the inpatient setting we see more and more diagnosis denials for Clinical and Coding reasons. Documentation remains at the center of many inpatient denials. Even with the electronic health record there are STILL gaps and holes in the clinical documentation. Clinical criteria and even medical coding is not always black and white. Payers are using AI and algorithms to enhance and narrow the focus for specific diagnoses being denied. Hospitals need to be more proactive rather than reactive to address, and solve the issue of hospital inpatient denials, especially for Sepsis, Acute Respiratory Failure, Acute Renal Failure and even Morbid Obesity. There certainly can be ups and downs to improve appeals and processes to improve for success.

Objectives

• Discuss the "state” of clinical and coding payer denials and best practice tracking
• Share key diagnostic documentation areas for improvement
• Review top payer coding and clinical denials and the reasoning (Sepsis, Respiratory Failure, AKI & Pneumonia)
• Gain a better understanding of payer clinical and coding denials to leverage appeal strategies, documentation improvement and compliance
• Learn ways to help reduce payer denials and enhance process improvement using data and a Denial Mgmt. Assmt. to decrease risks

Webinar Date: This was presented as part of OHIMA's 2025 Virtual Coding Seminar that was held on September 19, 2025.
Duration: 1 hour

Speaker: Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, is a HIM Coding Compliance Professional and Leader for over 40 years. She has a RHIA (Registered Health Information Administrator), a Clinical Documentation Improvement Practitioner (CDIP), a Certified Coding Specialist (CCS), and a Certified Clinical Documentation Specialist (CCDS). Gloryanne is also an AAPC (American Academy of Professional Coders) member. Ms. Bryant has conducted numerous educational programs and authored articles on ICD-10-CM/PCS and CPT coding and continues to do so. In addition, she’s provided MS-DRG, APR-DRGs, APC (OPPS), HCC, CDI, CAC, Leadership and Compliance focused seminars and workshops for hospital and physician-based coding staff, HIM Leaders and others in healthcare. Ms. Bryant has been an expert witness and consultant in the area of MS-DRGs, Documentation, Coding, Charges and Denials. She continues to advocate for healthcare compliance, improved clinical documentation, data quality and integrity through her educational programs and writings; and is passionate about helping healthcare have reliable coded data.

Click here to register for this webinar!

Cost: $25 Members / $35 Non-Members
AHIMA CEU*
Domain: Revenue Cycle Management

*AHIMA CEUs are also accepted by the AAPC! Check eligibility on the AAPC website.