Best Practices for Proactive Defense Against Clinical Validation Denials

Clinical Documentation Integrity Committee

Thursday, September 25, 2025 | 6–7:30PM EST

As physician advisors partnering to support CDI, we often take responsibility for supporting workflows established by the revenue cycle and CDI to address DRG-based clinical validation (CV) denials. Join us for this FREE session, where we share insights on our own experiences participating in DRG CV denials with particular emphasis on what opportunities can be leveraged at the point of care when clinical documentation entry takes place to reduce the likelihood of future CV denials. The discussion will include the following areas:

How do you capture trends in documentation improvement, either by diagnosis/topic and/or by clinician/specialty, and share that feedback constructively to improve the quality of future documentation?
What is the role of institutional/internal guidance documents for high-impact/high-reimbursement conditions in the CV denials process? Does having internal guidance documents improve your ability to successfully appeal CV denials? Do they improve consistency in documentation of conditions in scope to the policy? Does internal guidance policy play a role in contract negotiations with payers?
Has your institution incorporated opportunities identified by CV denials for documentation improvement into point-of-care tools available to clinicians?
Does your CDI program prioritize reviews for clinical validation into its daily work to mitigate denials? What type of data analytics can drive continuous improvement?
Does your institution hold clinical departments, service lines, or other clinical entities accountable to clinical validation denials issued due to sub-standard documentation?