Appeal writers want to know how to defend sepsis denials in the era of Sepsis-3. What’s the future for clinical validation denials and appeals when major payers declare their use of Sepsis-3 in their reviews? How can hospitals reconcile their sepsis criteria versus the payers’ criteria?
Here we present an update on what Denial Research Group/AppealMasters has learned over the years from appealing hundreds of clinical validation denials for sepsis. Hear what our experts have to say about the disconnect between payer criteria and hospital criteria. We reveal payer behaviors regarding auditing and denying sepsis codes. And, as always, we share proven, successful appeal strategies that you can use right away.
Learning Objectives:
- Describe recent trends in auditing, denials, and appeals of sepsis cases
- List common payer denial rationale
- Describe successful strategies to compose winning appeals when sepsis is denied, even though you got it right.
