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Preventing Denials: The Role of Facility-Based Clinical Definitions
Monitor Mondays
Payer-driven clinical validation is a common reason given by payers to remove ICD-10-CM/PCS diagnosis and procedure codes affecting reimbursement or quality-based payment models (e.g., the Centers for Medicare & Medicaid Services/CMS Hospital-Acquired Conditions), even though these codes are based on the documentation of licensed providers.
During the next Internet broadcast of the venerable Monitor Monday, Dr. James S. Kennedy of CDIMD will propose a strategy that engages payers in how patient conditions or treatments should be defined, diagnosed, and documented, elevating the practice of medicine and confronting denials that are often based on misinterpretations of current clinical literature.
Broadcast segments will also include these instantly recognizable features:
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
• Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.
