Description: Many providers have experienced a significant increase in clinical validation denials, citing lack of coding accuracy. This is a specific denial category that occurs when clinical evidence in the patient chart is inadequate to support a billed diagnosis. It is not the same as coding, billing or charging errors. It is important to understand the cause of these denials and develop strategies to improve the process. For example, if the provider documents Acute Respiratory Failure, the chart should include ABG values, whether the patient has chronic respiratory compromise and evidence of aggressive measures of oxygen intake. Documentation that is lacking in these areas may lead to denial of the claim. Regardless of your setting, it is important to quickly identify these denials and work with your providers to adequately support conditions documented in the record. Historically, coders have relied upon provider statements when coding for conditions managed in the current encounter. Recent payor trends of claims review have identified coding and documentation patterns in which provider statements did not contain supporting information necessary to validate the condition and how it was managed.

Webinar Date: This was presented as part of IHIMA’s 2025 Virtual Winter Conference – February 2025

Duration: 1 hour 

Speaker: Dorothy Steed, MSLD, CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CRCR, CICA, CPAR is an Independent Healthcare Consultant and Educator. She has served as a Medicare specialist and a physician audit supervisor for hospital systems with 49 years of experience in healthcare. She is an instructor at a state technical college and provides auditing & training in both facility and physician services. She is credentialed in medical coding, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance, clinical documentation improvement, revenue cycle and patient accounts. Additionally, she has participated in multiple healthcare audits and investigations for both plaintiff and defendant. She has provided review services for 2 state QIO organizations & served as an expert witness in several legal disputes. She holds a Master’s degree in Strategic Leadership Development.

Click HERE to register for this webinar!

Cost: $25 Members/ $35 Non-Members

1 AHIMA CEU*

Domain VIII: Revenue Cycle Management

*Relevant AHIMA CEUs are also accepted by the AAPC and ACDIS. Check eligibility on their website.