To avoid payer refusals for diagnoses like bacterial, aspiration, and viral pneumonia, you need to know the payer’s playbook. You need to know their language and how they interpret yours. You must understand the âlanguage of the insurer’s gameâ in order to describe your patient’s respiratory distress in terms consistent with diagnoses such as bacterial, aspiration and viral pneumonia. Unfortunately, too often, simple words like âimprovedâ or âdo betterâ are misunderstood by payers as âresolvedâ. And when that happens, payers exploit these blunders to reduce the severity of illness and reverse the intensity of care provided by your facility. These downgrades cost the health system a well-deserved income, which will have an impact on the delivery of care in the future.
But you can make that go away for good when you learn how to decode payer denials like you’ll do in this exclusive RACmonitor webcast led by medical consultant Andrew D. Markiewitz, MD. During this webcast, Dr. Markiewitz will help you understand the salient points that should be included in the clinical documentation that communicates the patient’s condition and management steps. It will explain to you the need to accurately describe the patient’s condition in terms that payers understand and are not likely to refute. You will learn to clearly communicate the patient’s condition from admission to discharge. Additionally, use reviewers will gain a better understanding of clinical decision making and the scoring systems used to determine the appropriate patient condition.
Best of all, and most importantly, you will learn how semantics can be misunderstood and used to argue against the reality of your patient’s status. Avoid these pitfalls and minimize ridiculous denials.
Why is this relevant:
Electronic medical records (EMRs) and related clinical documentation initiatives have not helped hospitals accurately describe the patient’s condition and do not provide the salient surrounding the proposed diagnosis and the appropriate management steps to obtain the results. optimal results for patients. This webcast will provide the direction needed to ensure attendees have the information they need to decode payer denials.
- How to define acute respiratory failure
- Learn the details supporting the criteria for bacterial pneumonia, including aspiration pneumonia
- Criteria for viral pneumonia, including COVID-19
- How to improve communication of patient progress
- Learn about management and treatment decisions and their documentation
Who should be present:
Staff responsible for refusals and appeals; nurses and review staff for use; medical advisers; CDI specialists; HIM coding and billing professionals; listeners