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