According to the recent RACTrac survey released from the American Hospital Association, 60% of claims reviewed by Recovery Auditors in the second quarter of 2016 were found to not have an overpayment.
Orders for services are a vital component of ensuring Medicare coverage. With the advent of computerized provider order entry (CPOE), it is important to review order templates in the electronic medical record (EMR) and the resulting order produced or printed in the formal legal medical record to ensure the templates meet requirements.
Just like the lyrics to the popular Gap Band song say, "You dropped a bomb on me… I won't forget it," there are definitely some changes in the 2017 ICD-10-CM Official Guidelines for Coding and Reporting that some of us may wish the Cooperating Parties will forget were ever mentioned.
As if coders and clinical documentation improvement specialists aren't under enough pressure as it is, the advent of the 2017 Official Guidelines for Coding and Reporting brings to the table new documentation requirements for pressure ulcer coding. The guidelines can be viewed here: www.cdc.gov/nchs/data/icd/10cmguidelines_2017_final.pdf .
This article is part two of a two-part series on the definition changes for sepsis. Reread part one in the October issue of BCCS. In my October Clinically Speaking column, we discussed the evolution of the definition of sepsis and its implications in clinical care (Sepsis-1, Sepsis-2, and Sepsis-3), quality measurement (CMS' SEP-1 core measure), and ICD-10-CM coding compliance.
The recent adoption of a refined version of the Patient Safety Indicator (PSI) 90 composite by the Agency forHealthcare Research and Quality (AHRQ) has a significant impact on what discharges are included in PSI 15 (Unrecognized Abdominopelvic Accidental Puncture Laceration Rate).
The new guideline for code assignment and clinical criteria in the 2017 ICD-10-CM Official Guidelines for Coding and Reporting does not mean clinical documentation improvement is going away; instead it just upped the ante for continued improvement.
With only 60 days between the OPPS final rule's release and the January 1 implementation date, providers will be ahead of the curve by spending time now and thinking about the processes they may need to review, change, or implement based on what CMS finalizes and the sort of financial impact the final rule is likely to have.
Q. Since ICD-10-CM code O24.415 (gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs) has been added for 2017, do we need to add which specific drug is being used by the patient when reporting the code?
CMS released the final rule implementing provisions of the Medicare Access and CHIP Reauthorization Act of 2015 on October 14, giving providers a timeline and outline of the quality programs and payment models that will replace the Sustainable Growth Rate and other programs.
