Facilities are overwhelmed by an onslaught of clinical validation denials for severe protein-calorie malnutrition and encephalopathy. These are two main targets of clinical validation denials because they are both major complications and comorbid conditions (MCCs). And because payers and reviewers are constantly changing the rules to give themselves the upper hand, many facilities are left scrambling and struggling with how to effectively protect these revenues.
But now you can turn the tables on these hungry payers and external auditors by learning an effective strategy that will destroy their denial rationale as you will learn during this exclusive RACmonitor webcast led by Kimberly Huff, clinical validation appeals coordinator for Providence Health System. Kimberly will show you exactly what these payers and reviewers are looking for in order to deny malnutrition and encephalopathy claims. She will walk you through how to effectively review these denials and the red-flag components in your charts and how her strategy actually collapses their rationale. Kim will give you her proven tips for creating an alliance within your organization to defend and protect against these denials. She will also demonstrate how providers need to document to make the record "audit-proof."
Register now to gain access to "Proven Strategies to Crush Clinical Validation Denials for Malnutrition and Encephalopathy."
Why This is Relevant:
Severe protein-calorie malnutrition — considered to be the majority of malnutrition denials — and encephalopathy are major complications and comorbid conditions (MCC) and when auditors arbitrarily remove an MCC that action negatively impacts payment to the facility.
- Learn how to identify key elements within the denial rationale
- Formulate a strategy for reviewing the record for what will be needed to appeal the denial
- Learn how to review the medical record, gaining new insight as to why the diagnosis was denied, and the rationale auditors used to deny the claim
- Know how to look for clinical indicators based upon widely accepted clinical criteria
- Learn how to prepare an effective, fact-based appeal letter
- Learn how to form an alliance among members of your team to defend erroneous denials.
Who Should Attend:
Denials and appeals professionals, clinical documentation integrity teams, coders and coding educators.