How to Appeal ICD-10-CM/PCS Coding and DRG Validation Denials

October 18, 2018

To provide participants with strategies that will enable them to prepare and write appeal arguments that will convince insurers to rescind ICD-10-CM coding and DRG validation denials.

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Learning outcomes

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

  • Establish a screening process for initial evaluation of a denial letter
  • Determine what is being denied, changed or added to the case from the external audit examples
  • Identify the key elements that are clinical/physical/work-up/treatment indicators for the appeal
  • Examine the DRG definitions manual, official coding guidelines, the ICD-10-CM code book index/tabular to identify appeal options/details such as "code also" and "code first” or “use additional code" instructions for evaluating the  denials and appeals
  • Compare common denial examples and appeals for new options to support your argument

Presenter

Deborah Gardner-Brown, RHIT, CCS, C-CDI, CI-CDI, CDIP, CCDS, CCMSCP, CPMA is the founder and President of Reimbursement Review Associates, Inc. Ms. Brown has more than 30 years of experience in both hospital and professional coding and revenue cycle management. She has held positions as director, administrator, and consultant in both acute care and outpatient health care settings. Ms. Brown’s expertise includes a range of revenue cycle and compliance surveillance programs/projects including performance improvement, data quality/analytics, utilization, quality, CDIP metrics management. Ms. Brown is also an accomplished auditor for E&M/CPT, APG, APC and MS-DRG, APR-DRG validation for coding compliance in both the acute care and outpatient care settings.

Deborah is an active speaker for several state component professional associations. She is also an AHIMA approved ICD-10-CM/PCS Trainer that has developed and presented educational material on several ICD-10-CM/PCS and CDI topics.  She holds the credentials of RHIT, CCS, and the CDIP credential from AHIMA. She is also certified as a C-CDI (Certified in Clinical Documentation Integrity), CI-CDI (Certified Instructor- Clinical Documentation Integrity) from the AIHCD; CCDS (Certified Clinical Documentation Specialist) from ACDIS; CPMA (Certified Professional Medical Auditor) from the AAPC; and CCMSCP (Certified CMS Compliance Professional) from the Progressive Health Care Compliance Institute. Ms. Brown is the founder of the NJ ACDIS state chapter association, and a member of AHIMA, NJHIMA, HCCA, AAPC, NJACDIS, AIHCD, WBL, MGMA, and ACDIS

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