Evolution of a Denials Management Process

November 15, 2018

Prevent/Minimize DRG based denials in an increasingly aggressive payer environment

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Learning outcomes

By the end of this webinar participants will know or be able to:

  • Reduce denials related to clinically unsupported diagnosis.
  • Identify trends where the “clinical” viewpoint differs from “coding” through development of a standardized communication method.
  • Describe the development of tracking and trending reports to measure performance and target areas for opportunity.

Presenters

Judy Kelly, MS, RHIA, CCS, CCS-P, CHDA, CPHI
Sr. Director of Health Information Management

Judy is the Sr. Director of Health Information Management for Rochester Regional Health in Rochester, NY.  Judy holds a MS in HIM and IT Leadership and graduate certificates in health information exchange and informatics. Judy has 32 years of health care experience encompassing a variety of roles including coding and clinical documentation improvement, utilization management, and revenue cycle management.

Kalena Britt, RN, BSN, CCM, CCDS
Director of Clinical Documentation Improvement

Kalena is the Director of the Clinical Documentation Improvement (CDI) department for Rochester Regional Health. Prior to being welcomed at Rochester Regional Health, she was a CDI Consultant for several years providing support to national health systems to establish CDI best practice, and provide employee education about the effects of their provider’s documentation and coding on their hospital’s quality metrics, length of stay, mortality index and reimbursement. Member of the Association of Clinical Documentation Specialists (ACDIS) and the Commission for Case Manager Certification (CCMC). Kalena attended the University of Rochester School of Nursing, and has been a Registered Nurse for more than 25 years with experience in critical care nursing, case management, utilization review, clinical documentation improvement and leadership.

Karen Linder, BS, RHIA, CCS, CCS-P, CHDA
Director of Coding

Karen is the Director of Coding for Rochester Regional Health in Rochester, NY., and oversees both facility and professional coding. Karen has 17 years of health care experience encompassing roles in coding, denials management, and compliance.

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