New to Denials

patricia.fountain@umassmemorial.orgpatricia.fountain@umassmemorial.org
in Denials

Hello, I have recently taken a position as the denials Director.  I have worked and managed CDS teams for a bit more than 10 years (wow long time and didn't even realize it - I loved it so much).  Any recommendations for a  newbie to denials?  I manage the RN denials team - bridging, denied days, medical necessity as well as the clinical auditing team RAC audits, cost outliers, DRG validation...  Appreciate any feedback, recommendations for resources, and in general great conversation with colleagues.  Thank you and stay safe all! 

Comments

  • hrboissonneaulthrboissonneault

    I recently started doing clinical validation denials and I find that for severe protein calorie malnutrition they are utilizing just ASPEN, so I include GLIM as well. I have had 5 over turned in the last month.

    Hope that helps!  Good Luck

  • patricia.fountain@umassmemorial.orgpatricia.fountain@umassmemorial.org

    Thank you, that's great information.  We used GLIM criteria when I was a CDS.  Great idea. 

    Appreciate your response and thank you!

    Patti


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