What constitutes respiratory failure? Even physicians cannot agree on clinical definitions to support a respiratory failure diagnosis. This leaves hospitals vulnerable to inconsistent coding and documentation – and susceptible to payer denials. In fact, denials of respiratory failure claims are increasing, and payers often cite lack of clinical validation as the reason. Given the significant revenue at stake, you need a proven approach to preventing and appealing denials.
You’ll gain a decided advantage with the help of this special ICD10monitor webcast. Our presenters, Dr. Robert Stein and Andrea Mathias, will walk you through the basics of respiratory failure, from both the coding and clinical validation perspectives. Once empowered with this foundational knowledge, you’ll be ready to dive into specific strategies, tactics and tools for effectively preventing and appealing respiratory failure denials.
Why This Is Relevant:
Improper coding of respiratory failure cases presents significant immediate and downstream risks, from major shifts in DRG payments, to the heightened risk of denials by various payers. Proactively protecting payments depends on coders who are familiar with the clinical aspects of respiratory failure and grounded in coding guidelines and code sequencing. When denials happen, as they inevitably will, you’ll need proven strategies to successfully appeal those determinations.
Learning Objectives:
- Understand trends related to acute respiratory failure payer denials
- Recognize the financial and other impacts of these denials
- Learn the fundamentals of acute and post-procedural respiratory failure, as well as how to clinically validate each type of diagnosis
- Master proven methods for crafting successful appeals of clinical validation denials for acute respiratory failure
- Discover the keys to constructing successful appeals of coding denials for acute respiratory failure
Who Should Attend:
Coders, HIM professionals, clinical documentation integrity (CDI) specialists, revenue integrity staff, denials management staff, quality staff and physician advisors.
Webcast Access Privileges:
Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available.
Learn more about webcast pricing and requirements →
Robert Stein, MD, CCDS
Dr. Stein is Medical Director at Enjoin. Possessing more than 25 years in active practice, he’s board-certified in internal medicine with subspecialties in critical care and pulmonary disease. Dr. Stein is an original member and is currently the medical director of the EICU physician team, providing telemedicine clinical support for BayCare Health System. He has provided numerous educational sessions for clients and physicians, focusing on several challenging clinical coding and documentation issues. Dr. Stein has also presented at industry conferences, including AHIMA and ACDIS, and he’s written articles for HCPro publications, Briefings on Coding Compliance and HIM Briefings.
Andrea Mathias, RHIT, CCS, CCS-P, CCDS
Andrea is a Senior Clinical Coding Analyst at Enjoin. She has been a HIM professional for more than 20 years, with a focus on revenue cycle management, consulting and CDI. She possesses a comprehensive knowledge of MS-DRG complex clinical denials and appeals, with an extensive understanding of clinical documentation improvement and revenue integrity best practices.