Clinical Coding Denial Prevention & Appeals Webinar

March 14, 2018
12:00 PM – 1:00 PM ET

Are coding denials by insurers such as Humana, Aetna, Blue Cross now taking over your time or the time of your denials management staff?

Clinical validation denials are now widespread and intrusive. Many of the targeted diagnoses have been documented clearly and consistently in the medical record but do not meet accepted published clinical indicators.

Official coding advice directs coders to code diagnoses that are documented by a physician as long as there is no conflicting documentation. Is the fact that the clinical “information” contained in the record does not “confirm” the diagnoses documented by the provider enough to remove the code(s) from the claim and pay the claim under a different DRG?

We have reviewed and appealed hundreds of such denials. We will share with clinical documentation improvement team the diagnoses receiving the most denials and clinical criteria used to make the denial. We will share our findings, successful appeals and those that were unsuccessful and why.

Concurrent clinical validation of the principal diagnosis, and CC/MCCs which determine the MS-DRG by CDI is necessary to ensure the documentation in the medical record supports the codes assigned thereby preventing future clinical validation denials. Learn how to compose physician queries that will obtain the clinical indicators to support or rule out a diagnosis that is not appropriate.

Program Objectives

• Understand difference between DRG validation and Clinical validation.
• Understand evidence-based clinical practice guidelines and how third party payers are using them to generate coding and/or DRG changes.
• Describe basic content of appeal letters and timely submission requirements.
• Develop internal tracking mechanisms to identify coding/DRG change denials and appeals.
• Discuss sample issues/cases involving coding/DRG changes due to clinical validation and/or documentation issues.

Speakers: Ms. Barbara Flynn, RHIA, CCS and Ms. Silvia G. Ortiz, MSHSA, RHIT, CMPSM

ICD-10-CM Diagnosis Coding Workshop Online Course

ICD-10-CM Diagnosis Coding Workshop Online Course

Start Date: March 5, 2018

End Date: April 30, 2018

Beginner to Intermediate level

Whether you have never coded diagnoses before or are just new to ICD-10-CM, this self-paced course is for you!

The online course materials are available to you 24 hours a day/7 days week, so you can fit learning into your personal schedule.

The basics of coding and the components of the ICD-10-CM code set are broken out, followed by a separate folder for each “chapter” [body system].

Every folder includes reading material complete with:

  • Realistic coding cases provide abstracting and coding practice, including step-by-step directions to determining the correct code, how many codes, and proper sequencing.
  • A&P descriptions, illustrations, and information on signs and symptoms enhance comprehension of the coding process, especially when creating queries to request additional information from providers.
  • Interactive exercises provide additional reinforcement.
  • Guidance Connection feature directs students directly to the applicable Official Guidelines, including specific Section, Chapter, and Subsection.

BONUS: One folder with more than 50 scenarios and case studies to practice coding and test yourself.

You will have until April 30, 2018 to finish and earn 10 CEUs.

CHPS Exam Prep Online Workshop

CHPS Exam Prep Online Workshop

Start Date: February 26, 2018
End Date: March 26, 2018

The CHPS credentialed professional is an expert in protecting the confidentiality, privacy, and security of patient health information from development and implementation to ongoing management and training of the workforce. The CHPS professional has the background and experience to understand and apply all federal and state regulations to ensure compliance across various types of healthcare organizations.

This course has four (4) modules, covering information for each of the 4 domains of the exam. Each module consists of a PowerPoint presentation + a CEU quiz. There is an ongoing discussion forum for you to ask any questions you may have, ask for clarifications, confirmations, or explanations for any of the content. The professional who will be your facilitator will provide answers for you within 48 hours.

The workshop will be open for 4 weeks and is accessible 24/7. These online workshops are designed to provide individuals in their FINAL stages of preparing to take the exam with the knowledge needed to better prepare for the examinations. These workshops are also designed to strengthen and reinforce competencies for ALL sections of the exam!

CDI for Medicare Risk Adjustment

March 7, 2018
11:30 AM – 12:30 PM PST

Learn about the Medicare Risk Adjustment model, including Risk Adjustment Factor (RAF) scores and Hierarchical Condition Categories (HCC), how provider documentation and coding of certain conditions affects the perceived severity of illness of your patients, and your overall rating as a healthcare provider or institution. Explore the proper documentation and coding of several common risk-adjusting diagnoses that present a challenge to providers today either because of existing incorrect documentation habits, differences between clinical and coding language, or increased specificity requirements for ICD-10-CM coding.

Presenter:  Osamah El-Aroud, MD, CRC

Outpatient CDI- What You Don’t Know Can be Detrimental!

Outpatient CDI- What You Don’t Know Can be Detrimental!

March 7, 2018
12:00 PM – 1:00 PM ET

This presentation will outline and discuss the key differentiating elements between inpatient and outpatient CDI, utilizing a case study hospital where a very robust outpatient CDI program was implemented to highlight how to develop a road map to organize, plan, develop and implement an highly successful program. Attendees will gain a strong appreciation and understanding of the primary drivers of documentation in the outpatient setting, what skill sets and core competencies are necessary as a proficient outpatient CDI specialists and how best to acquire the core knowledge and skill sets to begin an effective program.

Presenter: Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, CCDS, C-CDI, C-DAM


RHIT or RHIA Certification Exam Prep Online Workshop

Start Date: February 12, 2018

Choose the workshop for the exam you are preparing for!

These online workshops are designed to provide individuals in their FINAL stages of preparing to take the exam with the knowledge needed to better prepare for the examinations. These workshops are also designed to strengthen and reinforce competencies for ALL domains of the exam!

Learn More and Register