Clinical validation denials are still the hottest topic out there in the denial and appeal management world. AppealMasters began successfully appealing clinical validation denials almost a decade ago when Medicare’s Recovery Audit Contractors were the most voracious auditors out there.
Over the past several years the Commercial payers have ramped up their clinical validation audit efforts to levels never before seen. Successfully appealing these denials comes down to understanding the core issues behind the denials and implementing a few key appeal strategies. You can be successful in your appeals as well.
- List common clinical validation denial rationale.
- Recognize the core issues in clinical validation denials.
- Describe successful strategies to compose winning appeals when the payer denies the diagnosis, even though you got it right.