The shift from fee-for-service to value-based programs for outpatient payment systems has increased the need for outpatient CDI staff to review documentation for pertinent clinical factors.
Allen Frady, RN-BSN, CCDS, CCS, CRC, writes about guidance related to documenting acute respiratory insufficiency and gives tips to coders and CDI teams on what to do when the conditions are over-documented postoperatively.
Telehealth services continue to expand and claims for these services may already be under scrutiny by Medicare contractors. Debbie Mackaman, RHIA, CPCO, CCDS, writes about the differences between originating site and distant site services in addition to coding, billing, and reimbursement for telehealth services.
Coders and clinical documentation improvement specialists play a key role in the success of quality payment programs such as MIPS. This article describes the financial impact that hierarchical condition category coding has on provider reimbursement and the coder’s role in ensuring complete, accurate, and timely documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, writes that even though CDI specialists are not coders, it’s important to learn the rules and guidelines that coders follow. CDI teams need to reference guidance and guidelines in their daily work to ensure documentation is clear, concise, and supportive of accurate code assignment true to the patient’s story.
Valerie Rinkle, MPA, writes about CMS’ hospital prohibition of unbundling rules and a new outpatient date of service exception for molecular pathology and advanced diagnostic laboratory tests.
Paul Evans, RHIA, CCDS, CCS, CCS-P, tackles the various characteristics of creating a query and says that while all portions of any program, such as education and metrics, are important, the proper formulation of a query represents the most important task for a CDI professional.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the 2017 AMA CPT Symposium that could impact coders, including issues with the Table of Risk for E/M office visit codes and suggestions for E/M guideline revisions. This article is part two in a series.
Allen Frady, RN-BSN, CCDS, CCS, CRC, explains the value of tracking and understanding key performance indicators (KPI), and gives advice on how facilities can improve on its practices.
The amount of energy it takes to stay up to date on all the relevant payment and coding updates can be overwhelming, taking valuable time away from daily record review duties and activities.
