The CBIZ team of RNs and clinical coding specialists are ready to assist your hospital with medical necessity denials and DRG downgrades. Our team’s clinical expertise and payer-based experience provide a keen understanding of the logic behind the denial process and a thorough knowledge of how to appeal and overturn these claims. Our team can also provide guidance and educational support to address coding issues and clinical documentation. The CBIZ team can assist in the denial process by writing the first and second-level appeals. Our team will provide advocacy and support until final resolution of all appeals.
Today, one out of every five claims is denied. A majority of these denied claims are for lack of medical necessity. Most often, these claims go unchallenged and for many there are sufficient grounds for appeal.