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.
Providers should be preparing for another rulemaking cycle from CMS as we hit April, with the IPPS rule expected to include a discussion on how the existing payment system can address new and emerging cellular and gene therapies.
With the expansion of telehealth services, providers for both the originating site and distant site can also count on the expansion of Medicare contractor audits.
In 2015, I wrote 44 appeal letters challenging DRG validation/coding denials. In 2016, I wrote 88 appeal letters. Last year, I penned 159. We already received more than 40 DRG validation denials in January of this year. Does this trend sound familiar?
The implementation of an EHR is a multifaceted, comprehensive project for healthcare organizations. Though it affects every department and function in some way, the impact on medical record coding may be the most profound and complicated, with some organizations reporting a 20% decrease in coding productivity after EHR implementation.
Traditionally, the Office of Inspector General (OIG) Work Plan is released annually with focus areas identified for the upcoming year. However, as of June 2017, the decision was made to update the plan on a monthly basis to promote transparency by demonstrating a continuous effort to ensure compliance.
The fiscal year (FY) 2018 ICD-10-CM changes have now been active for several months. Though the volume of new codes is relatively small compared to previous updates, the impact on reimbursement has the potential to be quite large.
In response to ongoing criticism from physicians and the government’s own advisory panel against the Medicare Access and CHIP Reauthorization Act (MACRA), the U.S. House Committee on Ways and Means Subcommittee on Health held a hearing Wednesday, March 21, to defend the administration’s implementation strategy for the new physician payment program.
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.
Stress urinary incontinence is a common problem induced by minor physical stressors such as laughing, coughing, or sneezing. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about CPT coding for procedures such as sling operations and laparoscopies, used to treat urinary stress incontinence.
Even experienced coding professionals find injection and infusion coding confusing because CPT guidelines for these services differ from the guidelines for most other services. Review the drug administration hierarchy and guidelines for reporting therapeutic, prophylactic, and diagnostic injections and infusions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Osteoarthritis is the most common joint disorder in the United States and one of the leading causes of chronic pain and disability, according to the National Institutes of Health. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, examines ICD-10-CM/PCS coding and associated guidance for this condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When querying a physician to confirm the stage of a pressure ulcer, is it appropriate to ask questions that require the physician to mark “yes” or “no” responses to the query?
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.
An Office of Inspector General (OIG) audit of the University of Michigan Health System revealed noncompliance with four types of inpatient claims, including those associated with the billing of high-severity-level MS-DRGs.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews readmission rates and writes that if physicians learn the foundations of readmission measurement and implement some basic principles and workflows for reporting clinically accurate ICD-10-CM/PCS coding, hospitals can succeed with readmission measures.
