The Clinical Documentation Improvement Specialist's Guide to Audit Defense

How can your CDI program help defend your facility's medical records and claims submissions from recovery raiders to ensure the facility receives the appropriate reimbursement for its patient care?

The world of denials prevention and audit defense is filled with a host of watchdog agencies--an alphabet soup of acronyms--to audit claims and take back funds for inappropriate submissions. Your hospital must work to protect its reimbursement, and your CDI program can help. With more than a dozen years' experience working with CDI staff to defend claims and tighten procedures around documentation for auditor targets, author Trey La Charité, MD, FACP, SFHM, CCDS, provides step-by-step tools to help your program improve its denials prevention efforts.

This resource will help CDI professionals:

• Understand the scope of Recovery Auditors in private and governmental reimbursement efforts
• Identify various audit contractors and their respective scope of work
• Explain the importance of CDI and query compliance in denials prevention
• Identify potential documentation denial risks associated with electronic health records
• Establish effective appeals processes