Denials continue to be a pain point and significant challenge for every hospital across the nation, but Angelica Cage, MBA, BSN, RN, CCDS, CCS, CDIP , provides denial-proofed queries to show how establishing a diagnosis that is strongly supported by the available clinical evidence can reduce or eliminate clinical doubt with respect to the treated condition.
Certain diagnosis-related groups (DRGs) remain vulnerable to audits and denials, not only for DRG and clinical validation, but for medical necessity as well. Kim Conner, BSN, CCDS, CCDS-O , explores areas coding professionals can support when being proactive against these denials.
To comply with a summer court order, the FY 2025 Hospital Inpatient Prospective Payment System was revised to reduce payments for low wage hospitals. Review the updated policy to understand why these adjustments were implemented and what hospitals can expect going forward.
The majority of U.S. healthcare organizations struggle with denials and underpayments in all care settings, making it difficult to keep up with a meaningful manual appeals process. Learn how coding professionals can leverage technology to accurately capture and validate clinical data, ensuring proper coding and documentation while reducing the likelihood of denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Successfully managing inpatient stay denials should begin long before they occur and depends on having excellent case management, CDI, and coding departments. Although these departments have differing duties, Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , shows how they all play a part in ensuring that the final coded data is compliant and accurate.
Review a cross-sectional study published in the Journal of the American Medical Association that revealed people experiencing homelessness were significantly less likely to receive inpatient systemic therapy or procedures despite having a higher prevalence of more aggressive cancers and longer lengths of stay.
The majority of U.S. healthcare organizations struggle with denials and underpayments in all care settings, making it difficult to keep up with a meaningful manual appeals process. Learn how coding professionals can leverage technology to accurately capture and validate clinical data, ensuring proper coding and documentation while reducing the likelihood of denials.
Our experts answer questions on linking cellulitis and diabetes, coding COPD and associated conditions, and applying clinical criteria guidelines for sepsis.
The decision to implement AI in one’s health system is no small matter, but Katie Parsley, MSN, RN, CCDS, CPHQ, a CDI manager at Providence Health and Services in Oregon, shows how technology solutions employed at her organization have had an overall positive impact on clinical accuracy, prioritization, querying, and the efficiency of CDI staff.
Organizations need to decide how to manage the clinical validation conundrum effectively and consistently. Trey La Charité, MD, FACP, SFHM, CCS, CCDS, explores one denial prevention tactic that has proved most effective for his organization.
Shelley C. Safian, PhD, MAOM/HSM/HI, RHIA , explains ways administration can establish an organizational culture of legal and ethical responsibilities to maintain compliance and honor patients and staff.
HIPAA has protocols for when patients’ protected health information can be used for research and marketing. This means you must understand privacy rule limitations and your organization’s policies and procedures before releasing any PHI in these situations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The best technical security in the world cannot prevent breaches of protected health information if people are careless. Coders, billers, and HIM professionals should then learn to protect confidential health information by following proper security procedures and creating effective passwords.
CMS recently finalized a multitude of new price transparency requirements in the 2024 Outpatient Prospective Payment System (OPPS) final rule. These requirements have staggered enforcement deadlines, which means that revenue integrity professionals have their work cut out for them in the coming year to ensure their organization is in compliance.
CMS recently finalized a multitude of new price transparency requirements in the 2024 Outpatient Prospective Payment System (OPPS) final rule. These requirements have staggered enforcement deadlines, which means that revenue integrity professionals have their work cut out for them in the coming year to ensure their organization is in compliance.
The success of coding and CDI departments depends on collaboration with multiple entities. Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , illuminates how to promote healthy partnership.
Shelley C. Safian, PhD, MAOM/HSM/HI, RHIA , explains ways administration can establish an organizational culture of legal and ethical responsibilities to maintain compliance and honor patients and staff.
Kathy Dorich, MSN, RN, CCDS, CPHQ , explains two types of DRG reconciliation processes that she has implemented to alleviate conflict between coding and CDI departments.
Verbal conversations with providers regarding reportable conditions and procedures are considered verbal queries. Refresh how they should be memorialized within the record to maintain compliance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Make sure staff who handle audit requests understand when a missing signature should—or should not—trigger an automatic denial of your claims or prior authorization requests. Recent guidance from CMS clarifies how auditors should proceed when a medical record lacks a signature.
