Clinical validation queries
Currently, when we ask clinical validation queries, we do not take a financial impact. We only reconcile as "agreed and documented". Our vendor tells us that some facilities are taking a positive financial impact if they are successful in getting the supporting clinical evidence into the record. They are not addressing an impact of any kind if they are unable to get the documentation to support the diagnosis. We are struggling with how to handle these and would like to know how others address this. Our thought is that, if the diagnosis is documented, the coders are going to code it, so is it right for us to take a financial impact? We feel our role is trying to prevent a DRG downgrade by the payer and we haven't figured out a way to take "credit" for preventing a denial.