Health Information Management

Membership Update: Job description for denials management position

CDI Strategies, March 13, 2014

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

 

Not to beat a dead cliché, but the old adage “garbage in, garbage out” is as true in CDI as elsewhere in the world. The “garbage out” portion often refers to the negative affect of physician documentation on healthcare quality scores and public reporting but it also refers to fiscal intermediaries’ and auditors’ claims’ denials. If a physician does not appropriately capture the reasons for admission, it may not matter how specific the rest of the documentation gets since the claim most likely will be denied.
Many CDI programs work with their denials management or auditing departments to identify which diagnoses are being denied and to review documentation improvement opportunities with an eye toward reducing those denials.
In fact, a recent ACDIS poll shows that 56% of 381 respondents review records with an eye toward Recovery Auditor defense. It’s an upward trend: Answering a similar question, “Is your CDI team involved in Recovery Audit reviews and/or denial management?” only 32% said yes back in April of 2012.
 
Part of the job description requires analysis of clinical documentation, evidenced based criteria application outcomes, and physician documentation, along with complete review of the medical record related to clinical denials. It also calls for identification and communication of denial trends, and collaborative processes to reduce denials overall.
Although denials management is a distinctly different role from that of the concurrent CDI specialist, members of the Forms & Tools Review Committee highlighted some of the overlapping skill sets required for two positions, while emphasizing that CDI specialists should not be asked to play a dual role.
Editor’s Note: Read more about the CDI role in audit defense in the following articles:

 



Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs

  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • Strengthening Nurse-to-Nurse Relationships:

    This educational video will help nurses at all levels understand the issue of horizontal hostility. It provides the expert...

Most Popular