Sepsis-3 denial letter sample

Hi,

In our facility, I came across some Sepsis denials, mostly as we all know payers are starting to deny based on Sepsis 3 criteria. Most facilities have not adopted that as a practicing procedure. I was wondering if anyone has a good sample of these types of appeals?

I would appreciate your feedback,

Thanks

Nariman (MD, MPA/HA, CCDS)

Clinical Documentation Auditor

  

Comments

  • Hello,
     Were you able to locate some examples of denial letters for sepsis? We are also looking for samples as our recent denials have been unsuccessful.

    Thank you,
    Danielle Wirth, BSN, RN, CCDS

  • Yes,  you can Email me nariman.zeraatkardavani@pvhmc.org. I will share what I have, not much but hopefully will help.
  • Hello- I tried to email you and it bounced back. Is the email above correct?  I would like to share with you if you are still open to sharing. Thanks, Tracy Boldt
  • Hello- I tried to email you and it bounced back. Is the email above correct?  I would like to share with you if you are still open to sharing. Thanks, Tracy Boldt
    Maybe try again: Nariman.zeraatkardavani@pvhmc.org
  • Hello.  I would be interested in what you use for the sepsis 2 denials.  WE receive a lot of them.  We have not adopted the sepsis 3 criteria however, the sepsis 2 criteria has been met.  A lot of extra work on the back end for sure.

    Thank you.

    Sally Hamilton

    Sally.A.Hamilton@HealthPartners.com

  • Hello, in my new position, we are seeing a lot of denials based on Sepsis 3 Sofa criteria - < 2 of the 3 and it is denied for Sepsis:  elevated temp, HR, RR.  Seems short sighted to me especially if the patient has been treated as an outpatient and failed, on blockers or just received an antipyretic. Would also like to see what you are using for your sepsis denials.  Thank you - hope everyone is safe and staying healthy!
  • i would appreciate a copy as well culrich4@aol.com
  • What worked for us was to get a letter from our state's department of finance stating we must follow Sep-2 criteria. We include that with every appeal and have had success.
  • What worked for us was to get a letter from our state's department of finance stating we must follow Sep-2 criteria. We include that with every appeal and have had success.

    would you be willing to share that letter with me, as we have had no success, my email is heather.r.boissonneault@hitchcock.org
  • nzd1980 said:
    Yes,  you can Email me nariman.zeraatkardavani@pvhmc.org. I will share what I have, not much but hopefully will help.

    Hi Nariman, would you be willing to share with me as well? We have been unsuccessful in our Sepsis appeals. heather.r.boissonneault@hitchcock.org
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