What Can CDI Learn From All Those Pesky Denials

Description: How you can DODGE denials in REAL TIME.
Medical Necessity and clinical validation denials as well as DRG and level of care downgrades are rampant with third party payers taking a hardline stance in denying what seems to be medically necessary care. The culprit contributing to these unnecessary denials is insufficient and/or poor physician documentation throughout the entire patient encounter. A best practice reasonable strategy to proactively address these costly denials is to learn from these ongoing denials, engaging and deploying continuous quality improvement activities.

Attendees will learn:
• How to review a denied medical record, identify and uncover insufficiencies in documentation contributing to the denial and address with physicians
• Develop and implement actionable strategies to share best practice standards and principles of documentation with physicians as an integral part of your CDI program
• How to DODGE denials in REAL TIME and engage your physicians to avoid both obvious and subtle insufficiencies in documentation, resulting in better communication of the patient story.
• Work closely with denials and appeals staff to continually learn and act upon information gleaned and used in appeal letters to bring forth and educate physicians on enhanced value documentation, working smarter not harder

Live Webinar Date: October 22, 2020 1:00 PM
Duration: 1 hour

Speaker: Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, C-DAM is well-recognized and respected subject matter expert in the revenue cycle with a specialized emphasis and focus upon collaborating and working closely with physicians in promoting, advocating for, educating and achieving sustainable improvement in clinical documentation that accurately reflects and reports the communication of fully informed coordinated patient care. His experiences include working with a wide variety of healthcare systems spanning the entire spectrum ranging from critical access hospitals, community hospitals, Federal Qualified Healthcare Centers to large academic medical centers and fully integrated healthcare systems. He possesses twenty-five plus years of progressive practical hands on experience in clinical coding and documentation improvement, subscribing to the philosophy that quality of medical record documentation strongly correlates with overall quality of care achieved and the overall achievement of a high performing revenue cycle. Glenn has demonstrated the unique skill sets and core knowledge of principles and standards in best practices of clinical documentation, effectively and successfully driving physician engagement through proven strategies that create and foster a sustainable model for clinical documentation improvement. What sets Glenn apart in the clinical documentation improvement arena is the recognition of clinical documentation effectiveness, accuracy, completeness, and contextual consistency as fundamentally integral and intertwined with all components of the revenue cycle. He has conducted encompassing assessments of CDI programs utilizing a unique approach that embraces the concept of holistic documentation improvement that incorporates elements of complete, accurate and consistent documentation in support of quality patient care, medical necessity and optimal coding and reimbursement with financial and compliance integrity.  Glenn is a professional speaker, sought after for speaking engagements throughout the country on a wide variety of cutting edge thought provocative clinical documentation improvement topics and subjects. Glenn has served on the ACDIS Advisory Board as well as founded the WI ACDIS Chapter, leading a highly active chapter for six years. The inspiration for creation of a LinkedIn page titled Physician Documentation Improvement- A New Paradigm is  the goal of creating a forum for sharing thought provocative ideas and concepts on all things CDI including an awareness of the opportunity to transform the profession of CDI to one that truly supports the patient and the overall healthcare delivery model.

Speaker:  Heidi Hillstrom MBA, MSHSA, RN, PHN, CCDS, CCS, CDIP, AHIMA Approved CDI Trainer is a highly accomplished revenue cycle professional with a wide variety of experiences and accomplishments in clinical documentation improvement, case management, utilization review, coding, as well as denials and appeals. She has worked as a Clinical Documentation Improvement Manager and Denials and Appeals specialists for a medical center in the Midwest as well as specializing as an independent medical reviewer performing review, audits and appeals for health systems across the country.

Heidi recognizes the strong relationship between quality documentation, medical necessity, coding, reimbursement and revenue integrity, serving as a solid foundation for driving success in her CDI program. She has demonstrated the ability to affect positive change in overall physician behavioural patterns of documentation at her facility through forming of a trusting relationship with physician constituents, always putting the patient first as an integral part of the hospital’s CDI initiatives. Under Heidi’s direction and leadership of her CDI program, medical necessity and clinical validation denials have dropped 50% over two years while driving down third party payer level of care downgrades through adherence to a preventive denials avoidance documentation strategy promoting clinical documentation excellence with hospitalists and other physicians, advocating for “Getting Documentation Right The First Time” to prevent avoidable denials and the additional work associated with denials and appeals and physician Peer-to-Peer discussions.

Ms. Hillstrom is deeply involved and active in various revenue cycle activities including denials and appeals and utilization review that are directly impacted and supported by integrity and quality of the physician’s documentation and communication of patient care.

 

Click here to register for this webinar!

Cost: $25
1 AHIMA CEU / 1 AAPC CEU
Domain: Data Structure, Content and Information Governance

 

Course Details

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