Exit CDIP Certified Documentation Integrity Practitioner
Question 1 of 5
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Q1 Single choice

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?

  • A

    Remove sepsis from all claims where the diagnosis is not supported by sepsis 3 criteria.

  • B

    Appeal the denial because all payors must use the hospital's sepsis criteria when reviewing their claims.

  • C

    Query physicians when Sepsis-3 criteria is not met so they can provide additional documentation to support the diagnosis.

  • D

    Have the contracting department work with payors to obtain agreement on how sepsis will be clinically validated.

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