Most hospitals have been overwhelmed by Recovery Auditor (RA) requests for documentation. So it's no surprise that the RAs themselves seem to be equally as burdened with the task of processing those records.
CMS not only redefines inpatient status in the 2014 IPPS proposed rule, but it also discusses the ‘why’ and ‘how’ physicians should document the defining characteristic of all admissions: medical necessity. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain how the proposals could impact inpatient admissions.
General equivalence mapping (GEM) is a good tool to use to convert ICD-9-CM codes to ICD-10-CM, but the maps are only a tool. Lori Andersen, MS, and Patrick Romano, MD, MPH, explain to use GEMs as part of your ICD-10 coding transition.
The increasing complexity of the healthcare reimbursement system, quality initiatives, and the transition to ICD-10-CM/PCS put clinical documentation improvement programs in the spotlight . Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, discusses the importance of documentation improvement specialists.
The three-day payment window has been wrought with compliance challenges since its inception. In January, CMS updated the policy to provide additional clarification.
According to the Centers for Disease Control and Prevention, 31% of all American adults have high blood pressure, so odds are coders see the condition documented often. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-Approved ICD-10-CM/PCS Trainer , compares coding for hypertension in ICD-9-CM and ICD-10-CM.
CMS corrected edit 84, added five APCs to the I/OCE, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. In addition, CMS deleted all of the genetic testing modifiers, retroactive to January 1.
The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
With no national guidelines in place for facilities to use to determine evaluation and management (E/M) level, coders must apply their facility’s guidelines when coding an outpatient visit. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Joanne M. Becker, RHIT, CCS, CCS-P, CPC, CPC-I, use three ED case studies to highlight potential pitfalls for ED E/M leveling.
