A Summary of the AHIMA CDI and Coding Collablration in Denials Management Toolkit

摘要

HEALTHCARE INSURANCE PAYMENT structures in the United States have processes in place to monitor for appropriate payments to submitted insurance claims. Identifying the data to support an appropriate claim payment can be a complex process, which has an element of subjective judgments from claim reviewers. If a claim is deemed inappropriate, then it may be paid at a reduced amount or denied for payment altogether. It is vital for healthcare organizations to have a process in place to review claim denials and appeal when necessary. This process can be difficult and requires the participation of subject matter experts (SMEs) to accurately prepare a response when appealing a denied claim.