Templates perhaps for appeal rationale for Sepsis (Sepsis-3) and Severe Malnutrition denials.

namehernameher
in DENIALS & APPEALS

I wonder if we might achieve some synergy if we share and work together to improve appeals because a sepsis patient didn't meet SOFA or a severe malnutrition patient doesn't meet GLIM criteria. We have been using ASPEN/AND criteria for malnutrition.

Have there been any workgroups regarding the flood of denials and appeal language? Some insurance companies have incorporated Sepsis-3 in their provider manual but they pick and choose which parts of Sepsis-3 they want us to follow.

Thank you

Comments

  • virginialbryan@gmail.comvirginialbryan@gmail.com

    nameher - I can't specifically answer your question. However, I would love to discuss the challenges you are facing in responding to denials and the types of denials you are dealing with. I recently took a new job. We are discussing development of new services. One of those services is around denials. If you are willing to discuss further please contact me at virginia.bryan@cgi.com.

    If there is anyone else on this forum that would be willing to educate me in this area please feel free to contact me.

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