Sepsis Claims Denials: An Ounce of Prevention

Sepsis Claims Denials: An Ounce of Prevention

5 (2 votes)

Recorded On: 09/16/2021


Due to variation in the sepsis definitions and clinical criteria used, healthcare organizations, coders, frontline providers, and data abstractors often encounter confusion, reimbursement denials, and multiple clinical documentation queries. In this session Dr. Sean Townsend will review the differences between Sepsis-2 and Sepsis-3 definitions and discuss countermeasures that can be used to avoid sepsis claims denials.

Learning Objectives: 

At the end of the activity, the learner should be able to:

  • Understand the difference between Sepsis-2 and Sepsis-3 definitions;
  • Recognize claims for sepsis care are being denied based on varied definitions in the literature;
  • Deploy preventative countermeasures to avoid sepsis claims denials.

Target Audience: 

Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.

Sean R. Townsend, MD

Clinical Associate Professor of Medicine

University of California, San Francisco

Sean R. Townsend, MD, is Vice President of Quality & Safety at California Pacific Medical Center (CPMC) in San Francisco, California. He is also Clinical Associate Professor of Medicine at University of California, San Francisco. Dr. Townsend is a practicing intensivist in the Division of Pulmonary and Critical Care at CPMC. Dr. Townsend led the Institute for Healthcare Improvement’s (IHI) work on sepsis and served on the Surviving Sepsis Campaign (SSC) steering committee for many years. Dr. Townsend serves as measure steward for CMS’s national sepsis quality measure, SEP-1. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.3 contact hours.

Other healthcare professionals will receive a certificate of attendance for 1.0 contact hours.

Medical Disclaimer

The information on or available through this site is intended for educational purposes only. Sepsis Alliance does not represent or guarantee that information on or available through this site is applicable to any specific patient’s care or treatment. The educational content on or available through this site does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare professional. Sepsis Alliance recommends users consult their physician or healthcare professional regarding any questions about whether the information on or available through this site might apply to their individual treatment or care.

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