Sepsis-3 denial letter sample

nzd1980nzd1980
in Denials

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

  • danielle.wirth@spectrumhealth.orgdanielle.wirth@spectrumhealth.org
    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

  • nzd1980nzd1980
    Yes,  you can Email me nariman.zeraatkardavani@pvhmc.org. I will share what I have, not much but hopefully will help.
  • tracyaboldt@gmail.comtracyaboldt@gmail.com
    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
  • nzd1980nzd1980
    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
  • Sally.Hamilton@parknicollet.comSally.Hamilton@parknicollet.com

    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

  • patricia.fountain@umassmemorial.orgpatricia.fountain@umassmemorial.org
    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!
  • cindyulrichcindyulrich
    i would appreciate a copy as well culrich4@aol.com
  • mary.mastrandreamary.mastrandrea
    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.
  • hrboissonneaulthrboissonneault
    mary.mastrandrea said:
    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
  • hrboissonneaulthrboissonneault
    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
  • bhomanbhoman

    Would anyone be willing to share the sample appeal letter for sepsis with me?

  • olga.desiatkin@pvhmc.orgolga.desiatkin@pvhmc.org
    https://forums.acdis.org/discussion/comment/20451#Comment_20451

    Mary could you share the letter with me as well?

    Olga.Desiatkin@pvhmc.org

  • shefner74shefner74
    https://forums.acdis.org/discussion/comment/20451#Comment_20451

    Mary, would you mind sharing with me as well? And what state are you in? We are in North Carolina.

    Thanks! Shannon Hefner

    shefner@catawbavalleymc.org

  • mandypetremandypetre
    https://forums.acdis.org/discussion/comment/20451#Comment_20451

    Would you be able to share how you went about getting the letter from your state department of finance?

  • tbzkjwhite@aol.comtbzkjwhite@aol.com

    Please share the letter - brandy.white@coniferhealth.com

  • karen.larkin@sluhn.orgkaren.larkin@sluhn.org

    mary.mastrandreaMay 12, 2020

    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.

    I would also appreciate a copy of the letter and how you use it with your appeal. THANK YOU, karen.larkin@sluhn.org

  • robbimorris@sheridanhospital.orgrobbimorris@sheridanhospital.org

    I would appreciate a copy of the letter and how you use it with your appeal.


    Thank you for being willing to share!

    robbimorris@sheridanhospital.org

    Thank you,

    Robbi

  • heidi.hillstrom@slhduluth.comheidi.hillstrom@slhduluth.com

    I'm late to the party, but can I have a copy of the state letter that is being used in the appeal. what state is the letter from?


    heidi.hillstrom@slhduluth.com

  • cheryl.wall@vumc.orgcheryl.wall@vumc.org

    If available, please email me a copy of the denial letter example. Thank you for being willing to share!

    cheryl.wall@vumc.org

  • seaboldsseabolds

    Would you be willing to share the letter from the state indicating the need to use Sep 2 criteria, which is used to appeal the sepsis denials. Appreciate your assistance. Thank you.

    sandra.seabold@promedica.org

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