November 09, 2017 | | Comments 0
Print This Post
Email This Post

Q&A: Tracking denials

denials poll

Did you know 55% say CDI is involved in the denials management and appeals process?

Q: When looking at denials timelines, what information should be noted?

A: There are many critical time elements to capture during the denial appeals process. It is recommended that you add these to your denials database. If that is not possible, an alternative spreadsheet or database should be developed. The first date to track is the date that the denial or remittance advice (zero or underpayment) was received. The amount of time allowed to file your appeal will vary from payer to payer. When tracking timelines, it is important to note the:

  • Date of the denial letter
  • Remittance advice
  • Date you actually received it
  • Due date (the date the appeal must be received by the payer)
  • Date you actually sent your appeal

When establishing the due date, it is highly recommended you input a date that is 10 days earlier than the actual due date to ensure timeliness. These dates should also be built in for each level of appeal. Finally, you should track the payer’s response to your appeal for each level to ensure that they are timely. If not, you have the opportunity to request interest.

Editor’s note: This Q&A originally appeared in Revenue Cycle Advisor and was answered using information found in The Denials Management Training Handbook. Should you have any questions on this topic or others, please email ACDIS Editor Linnea Archibald (larchibald@acdis.org).

 

Entry Information

Filed Under: ACDISCDI ProfessionClinical Documentation ImprovementDenialsGrowing your programManagement

Tags:

Linnea Archibald About the Author: Linnea Archibald is the CDI editor for the Association of Clinical Documentation Improvement Specialists (ACDIS). In this role, she helps out with the website, blog, social media, newsletter, and the CDI Journal. If you have any questions, feel free to email her.

RSSPost a Comment  |  Trackback URL