Preventing revenue leakage is one of the core goals of a revenue integrity program, but with numerous sources of potential leaks, meeting this goal is often easier said than done. Michele Bear, DBA, MBA, CHRI, CRCR, CHC, CPC , focuses on key elements of successful revenue integrity programs that can prove to be effective and proactive.
CMS recently issued a bulletin highlighting new Medicare documentation guidelines and providing additional resources for documentation compliance. Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS , outlines the key takeaways from this latest guidance and emphasizes how health information, CDI, and coding teams play a role in compliant documentation.
Forensic medical coding is a specialized field that combines the precision of medical coding with the complexities of the legal system. Understanding the skills needed and the types of cases in which medical coding is essential becomes crucial to those looking to enter the field. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Coders play a crucial role in addressing clinical and coding denials, but they are far from alone in this effort. All HIM professionals are working together to create and implement comprehensive strategies that effectively reduce denials, fostering a unified approach to overcoming these challenges.
The Centers for Medicare & Medicaid Services has pulled information on health-related social needs (HRSN), a subset of broader social determinants of health factors, for state Medicaid and the Children’s Health Insurance Program, potentially making it harder for services that address HRSNs to be covered by these affected programs.
Although typically associated with outpatient services due to their use of HCPCS codes, chargemasters are also crucial in inpatient settings, as they serve as the foundation for billing services rendered during a patient’s hospital stay. Learn how inpatient coders can help maintain the financial health of their organizations through the proper understanding of chargemasters. Note : To access this free article, make sure you first register if you do not have a paid subscription.
One of the most frequent causes of hospital-acquired AKI is acute tubular necrosis (ATN). Improving documentation and coding practices for ATN involves not only recognizing the condition but also realizing the impact of coding ATN versus AKI, addressing common misconceptions in the HIM field, and fostering collaboration among CDI specialists, coding professionals, and providers. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Research of multiple countries on various continents and with varied complexity of healthcare environments reveals significant disparities in health outcomes and access to healthcare, and a staggering percentage of health outcomes are attributed to social determinants of health. Studying these countries shows differences in how socioeconomic issues are captured in documentation and coded using different patient classification systems, guidelines, and regulations.
ICD-10-CM official guidelines once stated that if there is conflicting documentation in the health record, the documentation of the attending physician supersedes that of any other provider. With that rule now gone, Cheryl Ericson, RN, MS, CCDS, CDIP , helps clarify who should be determining diagnoses.
Artificial intelligence is revolutionizing healthcare administration by enhancing efficiency, accuracy, and decision-making across various processes, with medical coding standing at the forefront of this transformation. Understanding AI-driven programs and the evolution of medical coding is essential for coders to thrive in this rapidly changing landscape. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Leveraging tools like clinical decision support (CDS) systems and physician queries can improve patient care and ensure documentation integrity. Yet medical coders need to ensure they use automated guidance without overstepping into clinical decision-making, maintaining the integrity of both documentation and coding while avoiding potential misinterpretations or misrepresentations of a patient’s condition.
Because discrepancies among payers’ diagnostic standards can lead to documentation issues, coding errors, and denials, revenue integrity professionals are encouraged to increase collaboration between CDI, coding, and clinical staff when addressing varying criteria. Discover further how coders play a key role in analyzing criteria, identifying denial trends, and ensuring providers receive proper training and education.
Review a study published in a recent edition of Health Affairs that discovered which type of hospitals are not evaluating their AI tools internally for accuracy or potential biases and explored whether models developed in-house or by external developers were supported more by local evaluations.
Cheryl Ericson, RN, MS, CCDS, CDIP , explores why CMS will begin collecting data in 2025 to measure performance on the Hospital Harm from Acute Kidney Injury (HH-AKI) electronic clinical quality measures (eCQM), particularly for those who may be less familiar with eCQM.
When denials are not justified, coding compliance auditors participate in the preparation of appeals using the content of the medical record and official reference materials that justify the coding that was submitted. Discover more about the important role coding compliance auditors play in denials management. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CDIP, CCS, CRC, CPHQ, CHDA, CRCR, ACPA-C , explores the complexities surrounding the classification of hospital admit types and the challenges caused by inconsistent definitions. By being aware of admit types, coders can ensure accurate reporting, benchmarking, and quality measurement.
Follow the career journey of Patricia Shirley, CPC-I, CPC , who started as a front office staff member and advanced through billing and coding roles before transitioning to the CDI field. Her experience highlights the benefits of adaptability and continuing education, demonstrating how a solid foundation in coding and compliance can help improve patient care and ensure accurate clinical documentation.
If denials are not going anywhere anytime soon, increasing at an alarming rate, and causing organizations to close, how do hospitals ameliorate this issue? Hospitals, including coders, can work to stem it by understanding the different types of denials, the problems they pose, and the tactics required to fight them.
Q: What were the AMA’s goals for revising evaluation and management (E/M) services that were implemented starting in January 2021 and continued in January 2023?
Health information management occupies a pinnacle position in the revenue cycle, and although the span of coding’s influence throughout a healthcare organization is very broad, its effects can also be found in numerous revenue cycle spokes, including preregistration and scheduling, coverage approvals, and case management. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
