Description: The volume of clinical validation queries is outpacing DRG denials at some organizations. Payors have a lot more latitude with clinical validation denials because there are few diagnoses with standardized definitions. Additionally, not all patients may fit standard definitions as they are often established using a heterogeneous population. This session will define clinical validation by comparing it with the more familiar DRG validation process. The presentation will examine key coding guidance, including when to issue a clinical validation query as part of an organization's denial management strategy. Lastly, the speaker will discuss how appealing a clinical validation query differs from appealing a DRG validation.

Objectives:

• Define clinical validation
• Discuss coding guidelines and their relationship to clinical validation
• Explain when a clinical validation query may be appropriate
• Compare and contrast clinical validation denials and DRG validation denials

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: Cheryl Ericson, RN, MS, BS, CCDS, CDIP, is a CDI subject matter expert with many speaking engagements and publications for various industry associations. She has helped establish industry guidance through contributions to white papers and practice briefs, including several American Health Information Management Association (AHIMA) practice briefs and white papers with the Association of Clinical Documentation Integrity Specialists (ACDIS) in the areas of clinical documentation improvement, denials management, quality, technology and querying. ​Cheryl is the current CDI Reporter for Talk Ten Tuesday and ICD-10 Monitor.

Click here to register for this webinar!

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

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