The CMS risk adjustment model uses Hierarchical Condition Categories (HCC) to calculate risk scores based on ICD-10 diagnoses. Review HCC coding do’s and don’ts to help your facility manage risk effectively, enhance shared savings, and provide patient-centered care.
CMS recently released both the calendar year (CY) 2019 Medicare Physician Fee Schedule and OPPS final rules last week, revising the payment structure for E/M office visits and expanding payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted, off-campus, provider-based departments.
This month we are pleased to introduce Deborah Clinard, CPC, who has 12 years of experience as a coder and who currently works as a practice manager at Women’s and Children’s Specialists, LLC in Nashville, Tennessee.
In the 2019 OPPS final rule, released November 2, CMS implemented several site-neutral payment policies, though the agency did delay or shelve other proposals due to stakeholder feedback.
Remittance processing and appeals are integral parts of the revenue cycle. When facilities submit a claim to Medicare, the hope is that the claim will be paid in full and in a timely manner, but that does not always happen.
Coding and documentation teams can replicate an organization’s overall denial avoidance and management program by scaling it to the scope of denials for which they are responsible. Lynette Kramer, MA, RHIA , outlines a four-step process that coding teams can use to monitor claim data and establish accountability for denials.
The FY 2019 ICD-10-CM update includes 54 code additions, three deletions, and 87 revisions to Chapter 19 of the ICD-10-CM Manual , “Injuries, Poisonings, and Certain Other Consequences of External Causes.” Review updated codes and guidelines for reporting burns, infections and sepsis following a procedure, drug abuse, and human trafficking. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What’s the difference between an incomplete miscarriage, a septic miscarriage, and a missed miscarriage and how would surgical treatments for these conditions be reported using CPT codes?
CMS released Transmittal 836 on October 19, clarified language in Chapter 6 of the Medicare Program Integrity Manual regarding medical review of diagnostic laboratory tests.
