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How are Sepsis Denials Impacting your Star Based Revenue Performance?
Our Services
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- Sepsis and DRG Dispute Review & Resolution Services
- Sepsis and Denials & Appeals Certification
- Coding Education
- Clinical Documentation Improvement
- DRG and Coding Validation Reviews
- DISRIP Retrospective Reviews
Sepsis Documentation
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Quality of care and performance based reimbursement requires precise documentation details for disease specificity, acuity, and treatment provided.
Sepsis is a high resource consumption medical condition that should be identified specifically in terms of type of sepsis, clinical findings, and or risk factors.
Sepsis should be documented with the NYS-DOH Sepsis Identification/Reporting requirements always in mind.
The Challenge
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External third party and payer audits for “Clinical Validation of Sepsis” are using Sepsis 3 or other criteria to deny payment for sepsis.
The sepsis denials are resulting in negative impact on sepsis reportable data, MS/APR DRG reimbursement, other bonus revenue associated “Star Rating” for quality of care performance measures.
These denials for Sepsis have a primary and secondary impact on Revenue Cycle.
Hospital Star Rating$
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The Sepsis-Star rating connection is worth millions!
- One Star Hospital status?
- Sepsis “Clinical Validation Denials”?
Readmission Mortality and Sepsis Denials are linked to Annual Performance Based Incentive Star Ratings Reimbursement.
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Sepsis Denials Impact on the Hospital Star Ratings
Nationwide, the most common hospital rating was three stars.
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In New York State
Of 151 hospitals graded statewide, 48 hospitals got a one-star grade.
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The only hospital to attain a five-star rating was Hospital for Special Surgery in New York City.
Two Targeted Solutions
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Sepsis Reimbursement Dispute Resolution Determinations:
Timely and Impartial Determination Review Services to Resolve Provider & Payer Clinical Sepsis DRG Payment Disputes.
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DSRIP Concurrent and Retrospective Focused Reviews:
Quarterly PQI/PDI diagnosis Re-Evaluation support by Coding, and Physician CDI Experts. Targeted Medical Record Review Services for All Hospital Acute DSRIP Admissions.
Experience Matters
Our Industry Leading DRG and Clinical Documentation Experts
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Deborah Gardner-Brown
RHIT, CCS, C-CDI, CDIP, CCDS, CCMSCP, CPMA
Ms. Gardner-Brown is a Subject Matter Expert, Speaker, DRG Dispute Resolution Examiner and experienced Auditor for the acute and outpatient care settings. She is also an AHIMA approved ICD-10- CM/PCS trainer that has developed and presented educational material on several ICD-10-CM/PCS and CDI topics.
Ms. Gardner-Brown has more than 30 years’ experience in both hospital and professional coding, clinical documentation improvement, denials management, and revenue cycle integrity.
Deborah Gardner-Brown is the founder of Sepsis Integrity Review Services, and Principal Consultant for Reimbursement Review Associates Inc.
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Dr. Keith Stokes
MD, C-DAM, CI-CDI, PAC-CDI
Dr. Keith stokes is a board-certified physician with a diverse career that includes experience as a clinic medical director, hospital chief of staff, and hospitalist medical director, consultant and physician advisor.
Dr. Stokes has served as a consultant for numerous hospitals, primarily focused in the areas of utilization management and clinical documentation improvement.
Dr. Stokes acquired DocuComp LLC in April of 2017 and is currently a certified Physician Advisor and a Clinical Documentation Improvement and Integrity instructor.
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- info@sepsisintegrityreviewservices
- P.O. Box 1109, Sayreville, NJ 08872
- 1-732-371-3834