Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P, CDIP, senior manager at Blue and Company in Indianapolis, an industry expert on ICD-10, provides preparation tips and action steps for ICD-10 implementation.
If you’re worried about getting your physicians trained for ICD-10, you’re not alone. Thea Campbell, MBA, RHIA, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Donna Smith, RHIA, and Sue Belley , MEd, RHIA, CPHQ, offer tips and strategies to educate physicians about the new code sets.
Basing a coder’s successful completion of a coding audit only on coding accuracy overlooks importance of local coverage determinations (LCD) and national coverage determinations (NCDs). Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains the role LCDs and NCDs play in determining practical day-to-day coding accuracy.
The publication of the final rule officially announcing a change in the ICD-10 compliance date from October 1, 2013 to October 1, 2014, ends the uncertainty surrounding ICD-10 implementation that has plagued the healthcare industry. Sue Bowman, MJ, RHIA, CCS, FAHIMA, details what healthcare organizations should be doing now to prepare.
Coders face many challenges when coding for services provided by teaching physicians, interns, residents, and students. Medicare has specific rules and regulations surrounding what services it will pay for when an intern, a resident, or a student provides services. Lori-Lynne A. Webb, CPC, COBGC, CCS-P, CCP, CHDA, details what coders need to see in the documentation before reporting these services.
Observation services can generate so much confusion that CMS actually asked for comments on observation and inpatient status as part of the 2013 OPPS proposed rule. Kimberly Anderwood Hoy, JD, CPC, and Deborah K. Hale, CCS, CCDS, help coders unravel the complexities of observation services.
The guiding principle is the definitive methodology used for all risk adjustment medical record reviews. Successful Medicare Advantage (MA) plans focus on early disease detection, coordination of care, and accurate reporting of members’ chronic conditions by primary care physicians, retrospective and prospective pursuits to drive and improve health outcomes. Holly J. Cassano, CPC, guides coders through the principles of risk adjustment for MA plans.
A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a third-party insurance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, explains the differences in the definition and application of the term medical necessity.
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
