Appealing Clinical Validation Denials for Sepsis

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Wednesday, December 20 | 2:00 PM EST

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It’s been almost two years since The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) was published. How has the new definition impacted payer behavior regarding audits, denials, and appeals?

Join us as we share what we’ve learned over the years from appealing hundreds of clinical validation denials for sepsis on behalf of our hospital clients. We will discuss SIRS with infection versus Sepsis – 3 criteria and whether the different definitions even matter. We’ll reveal payer behaviors regarding auditing and denying this diagnosis code. And, as always, we will share proven, successful appeal strategies that you can use right away.

What you will learn

  • Understand the difference between SIRS and Sepsis – 3 criteria
  • Understand payer behaviors regarding clinical validation audits for sepsis
  • Discover successful strategies to compose winning appeals when the sepsis diagnosis is denied, even though you got it right.

Don’t miss this excellent educational opportunity designed to better equip you for successful appeals.

Let Our Experts Equip You to Win

Denise Wilson, RN, MS, RRT, Vice President, Clinical Appeal Services

About Ms. Wilson:  Denise brings over thirty years of clinical experience and 12 years of appeals experience to her training. Denise is a  nationally recognized educator providing Appeal Training Program for Hospital Staffs.  She has personally trained some of the largest systems in the nation, has been a regular speaker at national and local conferences, and has presented hundreds of cases at the ALJ level with a 95% success rate.  She holds a Master of Science degree in Management Information Systems from the University of Illinois, Springfield, is a Registered Respiratory Therapist and Registered Nurse.  She is currently the Vice President of Clinical Audit and Appeal Services at AppealMasters.