Stop revenue leaks caused by payers denying claims for acute kidney injury (AKI). Rebut their denial rationales with appeal strategies while performing second level reviews of AKI and acute tubular necrosis (ATN) denials that can mitigate further denials.
Are you experiencing denials for acute kidney injury (AKI)? Are your physicians either over or under documenting AKI? If so, you’re not alone. One of the more prevalent claim denials is for AKI which is denied by payers due to specific criteria not being met. If that is occurring at your facility it is probably time for a meeting of the minds between clinical documentation integrity specialists (CDISs) and physicians as when to document AKI or when to query for AKI in the presence of certain criterion. Before you begin this meeting of the minds, you should bring your team together for this important educational webcast.
During this RACmonitor webcast, you and your team will learn how to recognize under and over documentation issues. You will learn how to formulate an effective appeal. You will also be better positioned to perform second level reviews on claims that contain AKI or ATN to determine if clinical documentation integrity (CDI) initiatives can be implemented or when they have been, whether they are successful. This suggested audit type performed pre-pay would also determine if AKI or ATN would be upheld or denied upon payer review. For example, after attending this webcast, you will understand if the physician is under or over documenting AKI as prerenal azotemia or renal insufficiency (or vice versa), or if the physician is over documenting AKI as ATN. This process will also ensure the criterion is being abstracted from the record and applied correctly by the payer as well as the auditors in house.
Register now to learn how to stop revenue leaks caused by payers denying claims for AKI and ATN.
Acute kidney injury (AKI) denials rank among the highest recoveries by third party payers. In many cases, these are denied as often an encephalopathy and severe malnutrition claims. Generally, AKI is denied by the payer due to specific criteria not being met. However, if it is a legitimate denial, it may be a case where the physician is documenting AKI when “renal insufficiency” may be more appropriate. In addition to that, sometimes physicians over document AKI as a more severe form of AKI, such as acute tubular necrosis (ATN). Therefore, ATN denials are common as well.
Revenue cycle managers and directors, denials and appeals professionals, HIM managers, chief financial officers, clinical documentation integrity teams, coders, coding educators, and physicians.