I am curious to know if your CDI teams are involved in assisting to compile RAC denial responses especially if the RAC is denying it due to the codes not meeting clinical indicators?
I have written many of our RAC responses, the coding manager is responsible for the DRG changes however the RAC denials are often more clinical than coding issues and the manager is not clinical. She basically sends me the denial letter, sets me up a template letter, with all the coding issues addressed, I add the clinical part and send it back to her. She sends it to the appropriate party and is responsible for monitoring of all responses etc. Since we started this process we have overturned many of our denials at the first level. We have also involved the physician on the case if the denial is a large sum. Hope this helps.
Comments
I have written many of our RAC responses, the coding manager is responsible for the DRG changes however the RAC denials are often more clinical than coding issues and the manager is not clinical. She basically sends me the denial letter, sets me up a template letter, with all the coding issues addressed, I add the clinical part and send it back to her. She sends it to the appropriate party and is responsible for monitoring of all responses etc. Since we started this process we have overturned many of our denials at the first level. We have also involved the physician on the case if the denial is a large sum. Hope this helps.
Deanna Holowczak, RN, MSN, CCDS
Clinical Documentation Specialist
St. John’s Riverside Hospital
dholowczak@riversidehealth.org
(914) 964-4580
Cell (914)560-6673