To avoid payer denials for diagnoses like bacterial, aspiration and viral pneumonia, you need to know the payer playbook. You need to know their language and how they interpret yours. You need to understand the "language of the insurers' game" in order to describe your patient's respiratory distress in terms that are consistent with diagnoses like bacterial, aspiration, and viral pneumonia. Regretfully, too many times, simple words like "improved" or "doing better" are misunderstood by payers as "resolved." And when that happens, payers exploit those gaffes to downgrade disease severity and negate the intensity of the care your facility has delivered. These downgrades cost the health system well-deserved revenue impacting care delivery in the future.
But you can make that go away for good when you learn how to decode payer denials as you will in this exclusive RACmonitor webcast led by physician advisor Andrew D. Markiewitz, MD. During this webcast, Dr. Markiewitz will help you understand the salient points that need to be included in the clinical documentation that communicates the patient's condition and management steps. He'll explain to you the need for accurately describing the patient's conditions in terms that payers understand and are not likely to refute. You'll learn how to clearly communicate the patient's condition from admission through to discharge. Moreover, utilization reviewers will better understand the clinical decision-making and the scoring systems that are used to determine appropriate patient status.
Best of all, and most importantly, you'll learn how semantics can be misunderstood and used to argue against the reality of your patient's status. Avoid these traps and minimize ridiculous denials.
Why This is Relevant:
Electronic medical records (EMRs) and related clinical documentation initiatives have not helped hospitals to accurately describe the patient's condition and do not provide the salient point surrounding the proposed diagnosis and the appropriate steps for management to obtain the optimal results for patients. This webcast will provide the direction needed to ensure that attendees will have the information they need to decode payer denials.
- How to define acute respiratory failure
- Learn the details supporting the criteria for bacterial pneumonia, including aspiration pneumonia
- The criteria for viral pneumonia, including COVID-19
- How to improve the communication of the patient's progress
- Learn management and treatment decisions and their documentation
Who Should Attend:
Denials and appeals staff; utilization review nurses and staff; physician advisors; CDI specialists; HIM coding and billing professionals; auditors
Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.