Although many provisions of the 2022 OPPS final rule are a light lift for hospitals, several have far-reaching implications. Apply these expert tips to ensure you're up to speed and aware of compliance pitfalls.
Revenue leakage can be caused by a number of factors including late filings, inconsistent documentation, and inaccurate coding. Fran Jurcak, MSN, RN, CCDS, CCDS-O , describes proactive strategies that coding professionals can use to address mid-revenue cycle leakage.
CMS is proposing to hit pause on major changes to MS-DRG designations while considering numerous changes to quality reporting and value programs, according to the fiscal year 2023 IPPS proposed rule. Read up on CMS’ proposed updates, which will impact inpatient hospitals beginning October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sometimes even the most seasoned revenue integrity professionals get stumped trying to navigate the maze of billing, charging, and coding rules that govern chargemaster structure. Review expert answers to perplexing chargemaster questions.
Determination of what is medically necessary for any given diagnosis is set forth by the healthcare industry’s Standard of Care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
Coding managers should not assume that they can review every coding guideline, Coding Clinic , or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Although most organizations do a good job of tracking denials by reason, payer, and volume, they miss the mark when communicating information about appeals, according to the results of HIM Briefings’ 2022 Denials Management Survey.
Nancy Treacy, MPH, RHIA, CDIP, CCS , describes her team’s experience implementing a streamlined audit process and offers advice to help others do the same. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Monitoring coding accuracy enables coding managers to spot error trends that could result in claim denials. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , describes two methods used to calculate coding accuracy based on a sample of claims.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality.
Organizations may opt to measure productivity using several methods, such as number of charts coded per day or per month, based on their needs, service lines, and other considerations. Some organizations use different productivity metrics for specific settings or account types.
CDI specialists must be able to apply both clinical and coding knowledge in order to discern relevant clinical conditions, and they must be able to analyze the quality of provider documentation and identify any gaps or inconsistencies in information between the health record and the associated data.
State and federal prosecutors continue to extract sizable settlements from practices that allegedly submitted fraudulent claims for one type of service—urine drug tests (UDT). In this article, Julia Kyles, CPC , breaks down fraudulent coding and billing patterns for UDT services.
Computer-assisted coding (CAC) technology analyzes healthcare documentation and selects codes based on specific phrases and terms. Review the pros and cons of using this software to perform inpatient coding and billing functions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
One of the biggest components of a leader’s role is to track, trend, and report on the department’s performance. Learn strategies for balancing priorities and time constraints and presenting key performance indicators to leadership.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and ICD-10-CM documentation requirements for traumatic fractures to resolve the coding challenges.
ACDIS and AHIMA recently released a position paper detailing CDI technology standards. The paper covers information on the variety of technology solutions currently available, strategies to assess compliance with CDI and coding practice guidelines, and methods for creating synergy between CDI and coding departments and novel technology solutions.
Fundamentally, what makes outpatient CDI different from inpatient CDI? A multitude of similarities exist between inpatient CDI basics and reviews, but outpatient CDI has many different areas of opportunity.
Coders continue to be in high demand, and given the importance of this function, evaluating coders’ performance is an essential task for revenue integrity. In this article, Lawrence A. Allen, MBA, CPC, CPMA, CEMA , makes the case for reevaluating coding performance.
