Denials

Discuss topics related to denials management, prevention, and appeals.

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Sepsis 2
SmbeckwithSmbeckwith
0
50
SmbeckwithSmbeckwith
Denial Related to Principle Diagnosis / Federal Registry
christine.butka@hmhn.orgchristine.butka@hmhn.org
3
183
cynthia.mead@nahealth.comcynthia.mead@nahealth.com
Productivity Standards for Denials
olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
1
67
karen.larkin@sluhn.orgkaren.larkin@sluhn.org
Sepsis-3 denial letter sample
nzd1980nzd1980
16
1.4K
karen.larkin@sluhn.orgkaren.larkin@sluhn.org
Clinical Validation for Sepsis when payer uses Sepsis-3
free2bkari@yahoo.comfree2bkari@yahoo.com
1
54
terrasproles@hotmail.comterrasproles@hotmail.com
GLIM criteria as basis for UHC denial for SPCM
cynthia.mead@nahealth.comcynthia.mead@nahealth.com
0
41
cynthia.mead@nahealth.comcynthia.mead@nahealth.com
allowable days
Angela.Edwards1@hshs.orgAngela.Edwards1@hshs.org
3
79
olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
Escalation
lmcluckie@wchosp.orglmcluckie@wchosp.org
0
38
lmcluckie@wchosp.orglmcluckie@wchosp.org
Orientation
kshumpertkshumpert
0
40
kshumpertkshumpert
Patient Status Denials
Angela.Edwards1@hshs.orgAngela.Edwards1@hshs.org
2
153
JMontg01JMontg01
Who uses Epic as a DRG denials platform?
nicole.newmannicole.newman
0
69
nicole.newmannicole.newman
Payer reviews
tracey-htracey-h
0
68
tracey-htracey-h
2021 DRG Denials
jaimeiamjaimeiam
1
271
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
After a 3rd level appeal
cdrumcdrum
5
401
hmhmay@ymail.comhmhmay@ymail.com
Denial after claim, but before audit!
bbogda55@gmail.combbogda55@gmail.com
2
121
kshumpertkshumpert
PSI Events
mcrawformcrawfor
0
160
mcrawformcrawfor
Payers not following coding clinic?
jozog@cayugamed.orgjozog@cayugamed.org
1
584
kshumpertkshumpert
Metabolic Acidosis
alee2020alee2020
5
1.4K
evanspx@sutterhealth.orgevanspx@sutterhealth.org
Short Stay Denials for total knee replacements
lauraehrlich@sunstoneconsulting.comlauraehrlich@sunstoneconsulting.com
1
82
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
Denial RN
Kerry.Termaat@phci.orgKerry.Termaat@phci.org
2
163
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
Malnutrition Denials
melanie.halpernmelanie.halpern
17
1.7K
stacy.vincent@enloe.orgstacy.vincent@enloe.org
Acute Renal Failure Denial
mbushey@tdstelme.netmbushey@tdstelme.net
5
381
evanspx@sutterhealth.orgevanspx@sutterhealth.org
Queries in Appeal letters
hrboissonneaulthrboissonneault
1
164
m1ghtymurs3m1ghtymurs3
Escalating to ALJ
mlsswlknsn122@gmail.commlsswlknsn122@gmail.com
0
82
mlsswlknsn122@gmail.commlsswlknsn122@gmail.com
When did GLIM become accepted criteria to determine Malnutrition
pattyvitasinski@comcast.netpattyvitasinski@comcast.net
4
316
pattyvitasinski@comcast.netpattyvitasinski@comcast.net
Acute Blood Loss Anemia
cgoeweycgoewey
0
266
cgoeweycgoewey
Sepsis
hrboissonneaulthrboissonneault
3
324
m1ghtymurs3m1ghtymurs3
BMI/Obesity
hrboissonneaulthrboissonneault
4
410
hrboissonneaulthrboissonneault
Acute Pulmonary Insufficiency Following Surgery (thoracic and non-thoracic)
hrboissonneaulthrboissonneault
4
900
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
TAVR and acute on chronic heart failure
nicole.newmannicole.newman
0
380
nicole.newmannicole.newman