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Appealing Clinical Validation Denials: A Team Effort

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Price: $229.00

Product Code: AR041819


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When payers issue clinical validation denials, they challenge diagnoses documented in the chart by the providers caring for the patient. Not simply the validity of diagnoses in question, but whether coding rules were violated. Assessment and potential appeal of these denials optimally involve four subsets of the hospital team: a) clinical documentation integrity (CDI), b) coding, c) contracting, and d) physician advisors. If your appeals team does not include all of these players, your process is not as optimized as it can be!

Once a working relationship between these departments is developed, the strategy to appeal clinical validation denials is strengthened immensely. This webcast will review point-by-point how to create a "dream team" at your organization and put their strength into action. From initial understanding of appeal processes available via contractual agreements to denial review and assessment and finally to effective appeal, you'll come away with a step-by-step map ready to implement.

Did you know you might have an opportunity to pursue telephonic appeals and not simply written appeals? Do you know precisely how the appeal process works with each individual payer your health system is involved with? Do you understand the difference between coding denials and clinical validation denials and the different ways they should be assessed and addressed? You will after watching this webinar. Presented by a physician advisor for a two-hospital health system in the Midwest who works closely with her CDI and coding teams, physician advisors will come away with a guide to engage their own teams. CDI/coding leadership will gain valuable tips on how to incorporate other members into the process in the most efficient way.


Why This is Relevant:

Clinical validation denials are issued more and more often from payers and establishing an effective review and appeal process is crucial to protect health system's revenue. If your method to address these denials does not involve members from contracting, CDI, coding, and your physician advisor you are likely missing opportunities to successfully appeal many of them.

Take this brief quiz to see if you and your team could benefit from this webcast:

  1. What's the difference between a coding denial and a clinical validation denial?
  2. How do the perspectives and professional backgrounds of clinical documentation specialists and coders differ when assessing clinical validation denials?
  3. Why might your denials and appeals team not have all of the information they need to effectively appeal clinical validation denials?
  4. Why should your physician advisor be involved in the appeals process for clinical validation denials?


Learning Objectives:

From this webcast, you will learn to…

  • Understand the differences between coding and clinical validation denials.
  • Appreciate how each part of the team contributes to a successful denial review and/or appeal.
  • Explain why collaboration between your system's contracting office and CDI/coding teams is necessary to appeal clinical validation denials as comprehensively as possible.
  • Prepare the review materials necessary to pursue successful telephonic appeals with payers.
  • Understand why some clinical validation denials should be accepted and how your team can learn from them.