The role of the coder has transitioned over the past few years to one that is more auditing-heavy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes how to effectively perform internal audits and educate providers on coding best practices.
Anthem announced that it may reject claims that contain a subsequent E/M service that’s linked to the same diagnosis as an earlier E/M encounter. Learn what Anthem’s modifier -25 policy means for providers and physician coders.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews the background of MS-DRGs, as frequently revising MS-DRG basics will ensure that inpatient coders have a thorough understanding of the MS-DRG intricacies, thus perfecting overall assignment and reimbursement accuracy.
Providers will find significant leeway in how they can report advance care planning (ACP) services for physicians given CMS’ open-ended coding requirements. Review potentially confusing CPT time rules and other obstacles that may be holding back providers from engaging in ACP services.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. In addition, because ED coding encompasses professional and facility billing, they may need to scour provider documentation to determine the correct E/M service level for both bill types.
Telehealth services are likely to promote health, wellness, and disease management, providing an avenue to offer efficient, high-quality care while supporting value-based care in a cost-effective manner. Although the benefit of telehealth is obvious and its value is continually highlighted by CMS, it appears the services are underutilized.
If we look at each element of a coding audit, we can see the benefits these coding reviews provide. Every healthcare organization and hospital should invest in routine, internal coding audits. The alternative is waiting until the payer conducts an audit, denies a claim, and incurs costs for the organization.
Many outpatient CDI professionals stepped into their roles blind—not knowing where to begin or how to tell if they were successful. However, as programs mature, they need to be able to track their progress for a number of reasons, including focusing physician education and justifying continued funding from organizational leadership.
This article reviews HCPro’s 2018 coding productivity survey and reviews data on factors that have affected coder productivity, remote coders, and collaboration between coders and CDI specialists, including charts coded per hour and coding accuracy standards.
Even on a small scale, the implementation of an outpatient clinical documentation improvement (CDI) program can be overwhelming. Review advice from CDI specialists on developing successful outpatient CDI programs that facilitate accurate coding and billing.
Establishing an outpatient CDI program can have substantial benefits. Recently, an outpatient CDI review project demonstrated there were many documentation improvement opportunities at a large family practice/internal medicine physician clinic.
Sarah Humbert, RHIA, and Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, explore three scenarios for onboarding new inpatient coders and provide valuable advice to prepare them for success.
Despite facing potential lawsuits and political opposition, CMS finalized some of its most controversial proposals in the 2019 OPPS final rule by implementing several site-neutral payment policies and 340B drug payment reductions.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Crystal R. Stalter, CPC, CCS-P, CDIP, says that there is still confusion around documenting patient stays to show quality, especially in the inpatient realm. Is it really as simple as documenting conditions to their fullest specificity or does it involve a more complex approach?
The CMS risk adjustment model uses Hierarchical Condition Categories (HCC) to calculate risk scores based on ICD-10 diagnoses. Review HCC coding do’s and don’ts to help your facility manage risk effectively, enhance shared savings, and provide patient-centered care.