In today’s regulatory environment, it’s imperative that healthcare professionals have processes in place to handle a variety of audits and insurance claims denials. To that end, AHIMA has released its CDI and Coding Collaboration in Denials Management Toolkit.
“This toolkit will discuss the appeals process for denials management as well as ways to prevent denials from occurring. The information provided is beneficial for new and experienced denials specialists,” according to the toolkit. “The focus of this toolkit will be on claim denials for medical necessity, coding, and clinical documentation. Each payer will have their own policies in place for claim reviews and denials. Many payers follow some of the same processes that Medicare utilizes; for that reason, this toolkit will focus largely on the Medicare denial process.”
The toolkit was prepared with new and experienced denials specialists. It includes sample appeals letters; sample policies and procedures; and tips for navigating the appeals process, tracking appeals and denials, and denials prevention.