Preventing Denials: The Role of Facility-Based Clinical Definitions
About this episode
Dr. James S. Kennedy discusses strategies to engage payers in clinical validation to prevent denials affecting reimbursement.
Payer-driven clinical validation is a common reason given by payers to remove ICD-10-CM/PCS diagnosis and procedure codes affecting reimbursement or quality-based payment models (e.g., the Centers for Medicare & Medicaid Services/CMS Hospital-Acquired Conditions), even though these codes are based on the documentation of licensed providers. During the next Internet broadcast of the venerable Monitor Monday, Dr. James S. Kennedy of CDIMD will propose a strategy that engages payers in how ...
Topics covered
- clinical validation
- ICD-10-CM
- reimbursement
- quality-based payment
- payer engagement
More episodes of Monitor Mondays
- The Latest Compliance Trap: Medicare Cost Reports
- Behavioral Health: Avoiding Common Pitfalls
- Avoiding the Next Claim Denial
- Seeking Compliance Across the Revenue Cycle
- Who will Blink First? 340B Health at Center Stage as Controversy Continues
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