Denials

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

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Managing DRG Denials
elaine.koetje@spectrumhealth.orgelaine.koetje@spectrumhealth.org
2
176
olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
Sepsis and Acute respiratory failure - calculated versus ABG P/F ratios
JlwardJlward
2
419
amarin.alexander@fideliscare.orgamarin.alexander@fideliscare.org
Denial for AKI "after optimal hydration"
rmalcolm@cvph.orgrmalcolm@cvph.org
4
763
cgoeweycgoewey
Acute Blood Loss Anemia
cgoeweycgoewey
3
1.6K
Sarah.priceSarah.price
Malnutrition Denials
melanie.halpernmelanie.halpern
18
2.1K
JlwardJlward
hospital criteria for acute respiratory failure
myu1@valleyhealth.commyu1@valleyhealth.com
1
382
JlwardJlward
Sepsis-3 denial letter sample
nzd1980nzd1980
20
2.1K
seaboldsseabolds
New vs Acute CHF
Dyan_Post_17992Dyan_Post_17992
1
337
annnd2009@gmail.comannnd2009@gmail.com
GLIM criteria as basis for UHC denial for SPCM
cynthia.mead@nahealth.comcynthia.mead@nahealth.com
1
259
heidi.hillstrom@slhduluth.comheidi.hillstrom@slhduluth.com
Productivity Standards for Denials
olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
2
273
heidi.hillstrom@slhduluth.comheidi.hillstrom@slhduluth.com
Cotiviti Denials for VA patients?
robbimorris@sheridanhospital.orgrobbimorris@sheridanhospital.org
1
195
heidi.hillstrom@slhduluth.comheidi.hillstrom@slhduluth.com
Sepsis 2
SmbeckwithSmbeckwith
1
270
dbutler@vidanthealth.comdbutler@vidanthealth.com
Denial Related to Principle Diagnosis / Federal Registry
christine.butka@hmhn.orgchristine.butka@hmhn.org
3
433
cynthia.mead@nahealth.comcynthia.mead@nahealth.com
Clinical Validation for Sepsis when payer uses Sepsis-3
free2bkari@yahoo.comfree2bkari@yahoo.com
1
242
terrasproles@hotmail.comterrasproles@hotmail.com
allowable days
aedwards@iodinesoftware.comaedwards@iodinesoftware.com
3
258
olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
Escalation
lmcluckie@wchosp.orglmcluckie@wchosp.org
0
96
lmcluckie@wchosp.orglmcluckie@wchosp.org
Orientation
kshumpertkshumpert
0
99
kshumpertkshumpert
Patient Status Denials
aedwards@iodinesoftware.comaedwards@iodinesoftware.com
2
291
JMontg01JMontg01
Who uses Epic as a DRG denials platform?
nicole.newmannicole.newman
0
145
nicole.newmannicole.newman
Payer reviews
tracey-htracey-h
0
123
tracey-htracey-h
2021 DRG Denials
jaimeiamjaimeiam
1
428
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
After a 3rd level appeal
cdrumcdrum
5
649
hmhmay@ymail.comhmhmay@ymail.com
Denial after claim, but before audit!
bbogda55@gmail.combbogda55@gmail.com
2
266
kshumpertkshumpert
PSI Events
mcrawformcrawfor
0
371
mcrawformcrawfor
Payers not following coding clinic?
jozog@cayugamed.orgjozog@cayugamed.org
1
1.3K
kshumpertkshumpert
Metabolic Acidosis
alee2020alee2020
5
2.2K
evanspx@sutterhealth.orgevanspx@sutterhealth.org
Short Stay Denials for total knee replacements
lauraehrlich@sunstoneconsulting.comlauraehrlich@sunstoneconsulting.com
1
146
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
Denial RN
Kerry.Termaat@phci.orgKerry.Termaat@phci.org
2
255
jcjohnson@premierhealth.comjcjohnson@premierhealth.com
Acute Renal Failure Denial
mbushey@tdstelme.netmbushey@tdstelme.net
5
559
evanspx@sutterhealth.orgevanspx@sutterhealth.org
Queries in Appeal letters
hrboissonneaulthrboissonneault
1
290
m1ghtymurs3m1ghtymurs3