2021 DRG Denials

We're getting increasing numbers of DRG Denials (for diagnoses such as Sepsis, Encephalopathy, Respiratory Failure, Malnutrition, AKI etc..)

We are trying to articulate the increasing demand on the CDI team. We have a few CDI who are specifically employed to write our responses to the denials.

I am interested in hearing from you about you volume of denials relative to the discharge volumes at your hospital. (For example, you're getting 20-25 denials per week, and discharge approximately 1500 patients per month)... or however you can describe it to me. Any trended data you have on this would be very appreciated!

Thanks in advance!


  • Greetings, I can't give you specific numbers as some of our denials do go back 3 years. I can tell you that the volume has become so high, we have contracted with a vendor to manage these for us. I just had a meeting with them yesterday and they shared that the majority of our denials are appealable. I think the payors are very good at this game whether it is DRG downgrades or the new trend of reducing the ED level of charges. Our vendor also breaks down each month by payer and by amount of downgrade so we can easily see what is happening. We then share this information with our contracting team. My guess is that most health systems are dealing with the same issues you have addressed.

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