The CDI and Coding Team Approach to Audits and Denials: The Best Defense is a Good Offense

The best approach to successful denials/appeal management is a proactive methodology incorporating a multidisciplinary team. Focus on a solid educational foundation, robust prevention tactics, and a well-developed process for data analysis to find success. Denial and appeal mitigation teams must be armed now to address denials that are evolving into a broad spectrum of denial rationales. Learn from our subject matter experts how to engage in a multidisciplinary approach to denials management that incorporates both reactive and proactive strategies.

Learning Outcomes:

  • Identify the main types of audits and denials.
  • Identify two of the benefits of close CDI/Coder collaboration.
  • Identify three specific strategies that clinical and revenue cycle professionals can adopt to support denials management.

Presenter: Garnette McLaughlin, DBA, RHIA, CCS, CDIP, CHDA, CCSFP. CICA

Garnette moved into the HIM field in 2011. Prior to discovering this fascinating profession, her background was in IT and management. She has over 15 years of experience in management, training, and customer service. After completing her Bachelor of Science in health informatics, Garnette became an inpatient coder for an academic tertiary care hospital. While her primary coding specialty is inpatient – she also codes ED, ancillary, and outpatient surgery. Her coding expertise paved the way to transition into the world of denials management. Her areas of specialty are writing winning appeals of coding denials and serving as an appointed representative in hearings. Additionally, Garnette has a passion for educating coding and CDI professionals regarding pro-active strategies to reduce the risk associated with audits and denials.

Presenter: Christi Drum, RN, BSN, CCDS, CCS

Christi is a registered nurse with over 16 years of experience in emergency services, interventional radiology, cardiovascular services, and administration.  In 2013, Christi joined the Clinical Documentation Integrity department where she completed concurrent and retrospective reviews with a broad work scope of DRG reimbursements, CC/MCC capture, SOI/ROM improvements, mortality reviews, and HAC and PSI improvements.  She found great success in query writing with excellent capture/agreement rates.  Christi also became the first CDI Educator for the health system and was privileged to share her CDI passion through teaching and training nurses and physicians.

Currently, Christi works for Intersect Healthcare + AppealMasters where she is a clinical appeals consultant, generating detailed and well-articulated appeal letters and presenting cases as the Administrative Law Judge level.  Her specialties lie in clinical validation and coding appeals.