Denial defense against auditors that ignore Official Guidelines for Coding and Reporting to uphold d

cindys@hollandhospital.orgcindys@hollandhospital.org
in Clinical & Coding
What official reference or language can be used in defense against auditors that ignore Official Guidelines for Coding and Reporting to uphold denials?

Thanks!

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Suggest you use the search feature in the library and search by this topic as several articles have been written on this topic.  It is frustrating when a 3rd party does not follow the Official Guidelines, and it seems this experience is fairly common.  At any rate, I could not offer any better insight than what you'd find by referencing articles in the ACDIS library on this topic.  We have several MDs that act as advisors to CDI programs whom have written on this topic.

    Paul

  • jozog@cayugamed.orgjozog@cayugamed.org
    We have gone so far as to appeal to a third party/external review for Dispute Resolution Appeal on Acute kidney injury. Our hospital won this case however the insurance company re-appealed and won. As of yet, we have not received a denial for AKI since from this payer.
  • cindys@hollandhospital.orgcindys@hollandhospital.org
    thanks to you both
Sign In or Register to comment.