Case scenario for determining dx

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    Responding to ADR dx dementia. Data submitted inconsistent. How to explain and reverse the denial of claim
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  4. 0
    I'm not sure what you're asking, Ellen. Can you give more information?
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    Yes, please elaborate.
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    Maybe it's the VA's Alternative Dispute Resolution?

    Not much you can do if the pt isn't hospice appropriate per FAST, PPS..
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    I am not sure what they are disputing. If you have a physicians diagnosis of dementia, its hard to argue that the pt doesn't have it. If this is for nursing home care with a managed care org like Molina or united healthcare, are they disputing the level of care you are wanting? You probably need to talk to the insurance/company nurse reviewer and see what info he/she is needing so you can dispute the denial. Generally speaking the company will want documentation of some sort--H&P, discharge summary, nurses/progress notes, Dr's notes, MDS, lab work, etc... Hope this is what you talking about... if not, more complete information may get you better responses.