Learn how to protect reimbursement when payers attempt to downgrade respiratory failure, malnutrition, encephalopathy and sepsis— four of the leading causes of claim denials.
DRG downgrading is a widespread tactic used by payers to reduce hospital payments by reducing DRGs and inappropriately denying relevant diagnostic codes. Typically, payers only deny meaningful codes that correlate with a CC or MCC or ones that would drastically change the principal diagnosis. But during this exclusive RACmonitor webcast, you and your team will receive the latest information on the ever-changing body of medical evidence on these denial-prone DRGs. You'll receive valuable tips for ideal documentation and learn the common definitions of these four codes, while gaining a deeper understanding of the underlying etiologies. You will have tools and techniques to ward off attempts by payers who often provide no reasoning for a specific denial, use outdated references, or create amalgamations from numerous irrelevant sources.
Although coding respiratory failure is straightforward, you will be armed with new information regarding malnutrition and sepsis— two codes that have seen significant increases in denials. You will also learn why documenting encephalopathy continues to challenge physicians and how appropriate documentation will achieve the most accurate representation of the patient's condition.
This webcast will also give you strategic information as to when to appeal a denial plus the diagnostic criteria for specific diagnostic codes.
But this approach to denial prevention and reimburse protection requires team work. That is why this webcast, focused on these criteria, is essential for providers, utilization review staff, clinical documentation integrity staff and case management. CDI education and appropriate diagnostic codes often parallel medical necessity and allow staff members to aid one another to most accurately represent the patient's severity of illness, intensity of service and subsequent medical necessity. Only a multidisciplinary team, working together can avoid denials in the first place and this webcast is the place to start.
Why This is Relevant:
A single DRG reduction due to a diagnostic code denial can change reimbursement by thousands of dollars. This could drastically reduce appropriate reimbursement from insurers to facilities.
From this exclusive RACmonitor webcast you will learn…
- The basics of denials
- How to avoid denials for diagnostic codes and DRG downgrades
- The common denial techniques
- Clinical criteria/definitions for common diagnostic codes
- About audit protection from current literature