Patient Status Denials
Our health system is seeing many cases that are being denied inpatient care and the suggestion is to bill observation on these cases. At this time Coding does coding denials, CDI is responsible for clinical validation denials and Care Mgmt does the status denials. We do not have any type of process communicating with Care Mgmt about the denials they are seeing. CDI has many concerns regarding this discussion. Some concern our KPI metrics, since theses are happening well after discharge they are messing with our data.
Wondering how other CDI programs are dealing with status denials. Do you have a denial team or do the independent departments handle? What does your workflow look like between CDI and Care Management? Is case status denials a huge issue at your facilities?
We know we need a process overhaul but just aren't sure where to start. Thank you all for your help!