How do you handle “unable to determine” query responses?

unable to determine

By Brian Murphy Unable to determine. Love it? Hate it? Or do you understand why it must (usually) be offered as a query option? The latest ACDIS-AHIMA guidance, Guidelines for Achieving a Compliant Query Practice, imply that “unable to determine” should typically (but crucially, not always) be offered to the physician in a traditional multiple-choice…

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Payer perspective: A conversation with Colleen Gianatasio

CDI and coding professionals typically recoil from the dreaded word, “payer.” After all, provider-payer relationships are often adversarial at best, hostile at worst. Clarify the diagnosis or procedure with the physician, apply the medical code … only to have the payer downcode or outright deny the claim.    My guest on today’s podcast understands the frustration…

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Explosive growth of Medicare Advantage covered lives requires organizational mindset shifts

medicare advantage

By Jason Jobes, SVP Consulting How do you incorporate the growth of rate of Medicare and/or Medicare Advantage in your organizations operational plans? Do you monitor changes in market share when considering population changes moving forward? As of April, 2023 there are 64.4 million Medicare beneficiaries in the country. This has grown from 57.9 million…

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