CDI Field Guide to Denials Prevention and Audit Defense

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CDI Field Guide to Denials Prevention and Audit Defense

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CDI Field Guide to Denials Prevention and Audit Defense

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CDI Field Guide to Denials Prevention and Audit Defense

Trey La Charité, MD, FACP, SFHM, CCDS 

How can your CDI program help defend your facility’s medical records and claims submissions from “recovery raiders” to ensure the facility receives the appropriate reimbursement for its patient care?

The world of denials prevention and audit defense is filled with a host of watchdog agencies—an alphabet soup of acronyms—to audit claims and take back funds for inappropriate submissions. Your hospital must work to protect its reimbursement, and your CDI program can help. With more than a dozen years’ experience working with CDI staff to defend claims and tighten procedures around documentation for auditor targets, author Trey La Charité, MD, FACP, SFHM, CCDS, provides step-by-step tools to help your program improve its denials prevention efforts.

This resource will help CDI professionals: 

  • Understand the scope of Recovery Auditors in private and governmental reimbursement efforts 
  • Identify various audit contractors and their respective scope of work 
  • Explain the importance of CDI and query compliance in denials prevention 
  • Identify potential documentation denial risks associated with electronic health records 
  •  Establish effective appeals processes 

About the Author: 

Trey La Charité, MD, FACP, SFHM, CCDS, is a hospitalist with the University of Tennessee Medical Center (UTMC) and a past ACDIS Advisory Board member. He serves as the physician advisor for UTMC’s clinical documentation integrity program, coding, and Recovery Auditor response. He is a regular contributor to CDI Journal, author of CDI Companion for Physician Advisors: Notes From the Field, co-author of The Physician Advisor’s Guide to Clinical Documentation Improvement, and a co-lead instructor for the popular Physician Advisor Boot Camp. 

Published: January 2017

Page count: 120
Dimensions: 7x9
ISBN: 978-1-55645-251-2

Table of Contents

  • Chapter 1: Understanding Healthcare Reimbursement 
  • Chapter 2: Foxes Watching the Henhouse: Why CDI Should Care About Recovery Auditors 
  • Chapter 3: Ten Rules to Maintain a Compliant CDI Program 
  • Chapter 4: Target Specific Recovery Auditor Tactics 
  • Chapter 5: How to Prevent Recovery Auditor Denials 
  • Chapter 6: EHR Problems to Watch Out For 
  • Chapter 7: How to Write a Successful Appeal 
  • Chapter 8: Epilogue 

Add Association of Clinical Documentation Integrity Specialists (ACDIS)

$20 discount on your one-year ACDIS Membership will be applied at check out.

ACDIS is a community of CDI professionals who share the latest tips, tools, and strategies to implement successful CDI programs and achieve professional growth.

ACDIS members receive: 

  • Advocacy and leadership from a peer-elected ACDIS Advisory Board, including peer-reviewed Position Papers and White Papers.
  • Weekly tips, news, and strategies in our e-newsletter, CDI Strategies
  • In-depth news and regulatory information, clinically-based articles, case studies on building successful CDI programs, and membership profiles in our bi-monthly electronic journal, the CDI Journal
  • An opportunity to network with peers and colleagues in the ACDIS Forum
  • Access to live and archived quarterly conference calls, hour-long networking discussions and an open Q&A with the ACDIS Advisory Board
  • Helpful tools accessed in our electronic Resource Library, including sample queries, policies, and archived conference presentations
  • Two free job postings a year, discounted additional posts, and the ability to post your resume on our Career Center
  • Opportunities to participate in an Official ACDIS Local Chapter in your area, under the leadership of the Chapter Advisory Board
  • Discounts to the annual ACDIS conference, CCDS certification, and CDI Boot Camps

To explore all that ACDIS has to offer, please
visit the ACDIS Web site.