Câu 32: CDIP: Certified Documentation Integrity Practitioner

The facility has received a clinical validation denial for sepsis. The denial states sepsis is not a clinically valid diagnosis because it does not meet Sepsis-3 criteria. The facility has a policy stating it uses Sepsis-2 criteria. What is the BEST next step?

1. A. Have the contracting department work with payors to obtain agreement on how sepsis will be clinically validated.
2. B. Remove sepsis from all claims where the diagnosis is not supported by sepsis 3 criteria.
3. C. Appeal the denial because all payors must use the hospital's sepsis criteria when reviewing their claims.
4. D. Query physicians when Sepsis-3 criteria is not met so they can provide additional documentation to support the diagnosis. — đáp án hiện tại