Denial rates...what's average?
Trying to evaluate our CDI practices and wondering what your DRG claim denial rate is based on Clinical Validation....that is, what % of your inpatient discharge claims are denied based coding errors and what % of your inpatient claims are denied based on third-party clinical validation? Thanks in advance for your help.
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Our DRG downgrades have increased in 2020. The problem with trying to determine the percentage is that some of these downgrades are 3 years old. Rather than focusing on that, we are tracking them by year received, whether we appealed them, or not. Then we provide physician education when we are unable to appeal. When we appeal, we also track our wins, losses, secondary, and final appeals too.