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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Legal eagle: Healthcare denials through the eyes of Sarah Mendiola

Denials are a reality of life in the mid-revenue cycle. And they’re not going anywhere. As Medicare Advantage (MA) grows—MA Organizations statistically deny more care than traditional Medicare—the volume of denied claims will only keep growing. I wanted to talk about this subject with someone who not only understands the current mine-filled landscape, but knows…

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Boston strong: Climbing the U.S. News and World Report Best Hospitals rankings with CDI Director Deb Jones

Since taking on the CDI director role at Brigham at Women’s Hospital in October 2017, Deb Jones has made big changes with big impact. These include:   A deep focus on risk adjustment and mortality reviews. Boston is an incredibly competitive healthcare environment with 25 hospitals operating within the city. Patients have a choice of…

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