Q: We are experiencing post-payment audits that result in denials of inpatient claims. Our coders and CDI leaders are vehement that the patient meets MCG and/or coding guidelines, but the payer is using clinical results from the patient as their justification. It seems as if they are ignoring all established guidelines. If these are inappropriate denials, how do we fight them?
The American Medical Association recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old.
With thousands of Medicare patients discharged to post-acute care facilities annually, hospitals need to identify claims that failed to transfer under Medicare’s Post-Acute Care Transfer rules....
The NAHRI Leadership Council is pleased to invite you to participate in our 2022 NAHRI Leadership Council Survey: Claims Edits. This brief survey will help the NAHRI Leadership Council analyze claims edits from the perspective of workflows, resolution, tracking and monitoring, and resource use.
The COVID-19 pandemic has caused many departments to shift to working remotely over the last couple of years. Learn how management strategies have adapted.
Although the diagnoses most often targeted for denials remain familiar, payers’ denials reasons and strategies are constantly evolving. Use fresh approaches and real data to address and avoid denials.
