James S. Kennedy, MD, CCS, CDIP, reviews important coding recommendations mentioned in various Medicare Quarterly Provider Compliance Newsletters, covering the MS-DRG postacute discharge policy, readmissions to the same hospital on the day of discharge, and postoperative respiratory failure.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , writes about how one of the many coder obligations is to report noncompliant activities and provides information on how to do this anonymously. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
Q: I manage an inpatient coding department, and I am considering having them cross-trained. Are all coders usually cross-trained? And where would be the best place to train my staff?
A clinical documentation improvement (CDI) team can rapidly lead to quality improvements, according to a recent survey conducted by Black Book Market Research.
James S. Kennedy, MD, CCS, CDIP, says that since the clinical intent and language of physicians does not translate into the administrative language of ICD-10-CM, understanding and embracing both their clinical foundations is essential to accurately measure outcomes and ensure coding compliance.
Shannon Newell, RHIA, CCS, explains that pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program, as well as the Hospital Readmission Reduction Program, and conveys what CDI teams can do to help.
The 2017 ICD-10-CM Official Guidelines for Coding and Reporting brought many changes and updates for coders, and present-on-admission (POA) reporting was not excluded. Completely understanding POA guidelines is necessary for any inpatient coder.
Q: If a complication is clearly documented as unavoidable or due to a complex situation, should it be coded even if an intervention was done to correct it?
CMS recently made an administrative settlement process available for inpatient status claims. This process is open to eligible hospitals willing to withdraw pending appeals in exchange for a timely partial payment, or 66% of the net allowable amount, CMS said in the statement.
Trey La Charité, MD, FACP, CCDS , notes that getting a handle on a facilities’ case-mix index (CMI) fluctuations can be difficult, and shares insights to how CDI teams can handle these CMI difficulties.
