Making Denial an Opportunity

Describing the differences in documentation for Inpatient per commercial guidelines are sometimes quite different from what we learned about in medical school or during training in residency. Documenting the presence of certain relevant findings can help promote approvals for Inpatient can minimize denials. It is important to not over and/or under document.

Learning Objectives

At the conclusion of this activity, participants will be able to:

• Interpret and recognize the importance of specific documentation, verbiage and patient status as it pertains to claim.
• Illustrate examples of actual cases and how they could have been improved.
• Compare commonly scrutinized conditions or diagnoses and offer suggestions for avoiding denials.
• Define guidelines of Managed Care Plans / Commercial Plans to better understand the process in order to minimize denials.

Presenter:

• Hemet Gupta, MD, MSc | Lead National Educator and Medical Director of Advisory Services, Sound Advisory Services