Talk Ten Tuesdays

Dealing with Coding and Clinical Validation Denials with Medicare Advantage Organizations

September 29, 2020 Timothy Powell, CPA | Laurie M. Johnson | Rose T. Dun | H. Steven Moffic | Edward Hu, MD | Erica Remer, MD Episode 433
Talk Ten Tuesdays
Dealing with Coding and Clinical Validation Denials with Medicare Advantage Organizations
Chapters
Talk Ten Tuesdays
Dealing with Coding and Clinical Validation Denials with Medicare Advantage Organizations
Sep 29, 2020 Episode 433
Timothy Powell, CPA | Laurie M. Johnson | Rose T. Dun | H. Steven Moffic | Edward Hu, MD | Erica Remer, MD

The Centers for Medicare & Medicaid Services (CMS) has ordered Medicare Advantage Organization (MAO), -hired subcontractors, to stop issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized.  

Reporting our lead story during this edition of Talk Ten Tuesdays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. Dr. Hu was one of several healthcare executives who convinced CMS to issue a recent memo outlining this change. Dr. Hu will explain the coding significance of this new directive, particularly as it relates to coding and clinical validation denials, which by definition occur retrospectively, and often after a claim was initially paid.
 
The live broadcast will also feature these other segments:

  • The Dunn Report: National health information management (HIM) expert and past president of the American Health Information Management Association (AHIMA), Rose Dunn, returns to the broadcast to report the best approach to dealing with line-item claim denials.

  • Mental Health Report: H. Steven Moffic, MD, one of America’s foremost psychiatrists, returns to the broadcast to report on how cataclysmic events, here at home and abroad, are impacting our mental health.

  • News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.

  • The Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, returns to the broadcast to report on the need for facilities to develop their own coding guidelines.

  • TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.
Show Notes

The Centers for Medicare & Medicaid Services (CMS) has ordered Medicare Advantage Organization (MAO), -hired subcontractors, to stop issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized.  

Reporting our lead story during this edition of Talk Ten Tuesdays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. Dr. Hu was one of several healthcare executives who convinced CMS to issue a recent memo outlining this change. Dr. Hu will explain the coding significance of this new directive, particularly as it relates to coding and clinical validation denials, which by definition occur retrospectively, and often after a claim was initially paid.
 
The live broadcast will also feature these other segments:

  • The Dunn Report: National health information management (HIM) expert and past president of the American Health Information Management Association (AHIMA), Rose Dunn, returns to the broadcast to report the best approach to dealing with line-item claim denials.

  • Mental Health Report: H. Steven Moffic, MD, one of America’s foremost psychiatrists, returns to the broadcast to report on how cataclysmic events, here at home and abroad, are impacting our mental health.

  • News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.

  • The Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, returns to the broadcast to report on the need for facilities to develop their own coding guidelines.

  • TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.