The finalized fiscal year (FY) 2021 ICD-10-CM and ICD-10-PCS code sets were recently released in the FY 2021 IPPS final rule, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes.
It’s more important than ever that organizations keep ahead of COVID-19 ICD-10-CM and MS-DRG audits and denials. The financial strain that many organizations are under makes it imperative that they minimize disruptions to revenue.
A few years ago, there was a change of attitude within seizure medicine that manifested itself as new terminology. The older term “pseudoseizure” was replaced by the phrase “psychogenic non-epileptogenic seizure.”
Valerie A. Rinkle, MPA, CHRI , reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews healthcare compliance as a whole, and says it is important to be aware of these healthcare compliance risks, especially in ICD-10-CM reporting.
CMS released the fiscal year (FY) 2021 IPPS final rule on September 2. In this article, we will review key priorities for the coming FY, including a continuing emphasis on addressing disparities in reimbursement between urban and rural hospitals and expanding beneficiary access to cutting-edge technologies.
CMS recently released the fiscal year ( FY) 2021 IPPS final rule , which increased hospital payment rates, created new MS-DRGs, and finalized CC/MCC designations.
Valerie A. Rinkle, MPA, CHRI, reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August. Read about these proposals which if finalized, will impact hospital billing and payment starting January 1.
Dee Jones, CFO, describes eight ways 340B covered entities can optimize their 340B programs to gain immediate operational efficiencies while accelerating cash flow and savings.
Because of the complexity and frequency of ischemic stroke admissions, inpatient coders should review clinical criteria and ICD-10-CM reporting regularly for this diagnosis to ensure accurate coding and reimbursement.
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August.
This increase in alcohol-related deaths is consistent with reports of increases in alcohol-related illnesses and injuries during the same period. This study highlights the fact that alcohol-related admissions are not uncommon, which is why inpatient coders should brush up on reporting these disorders in ICD-10-CM.
Familiarize yourself with notable code updates in the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule, including new E/M reporting guidelines and CPT® codes for lung biopsies, auditory testing, and chronic care management.
Medicare’s rules for reporting blood products and applying the Part B blood deductible can be confusing. Judith L. Kares, JD , writes about unique HCPCS reporting and billing rules for blood products and related services reimbursed under the OPPS.
CMS released the calendar year (CY) 2021 MPFS and OPPS proposed rules on August 3, introducing new CPT codes, reducing the PFS conversion factor by nearly 11%, and seeking commentary on how to gradually eliminate the inpatient only list.
Bill Wagner, CHPS, CPCO , unpacks findings from a survey conducted by KIWI-TEK, a medical coding company in Indianapolis, that asked 157 coders how the novel coronavirus (COVID-19) pandemic has impacted their finances, workflow, and career prospects.
Familiarize yourself with proposed updates to the Medicare Physician Fee Schedule (MPFS), including plans to significantly revise the E/M coding guidelines and extend telehealth flexibilities beyond the COVID-19 public health emergency.
EHRs have fundamentally changed the healthcare industry. The wealth of data they’ve generated has been a boon to research and population health—and has also helped payers use sophisticated data analytics to drive denials.
HIM directors’ and managers’ salaries have largely held steady, but the economic impact of the COVID-19 pandemic is making itself felt. Learn how your salary compares to your peers’ and what you can do to improve your earning power in the future.
As the U.S. slowly tries to recover from the novel coronavirus (COVID-19) pandemic, the country might not ever be the same. States have been trying to reopen to regain their local economy, but in April, the U.S. unemployment rate was at the highest it’s ever been since the Great Depression.
Valerie Rinkle, MPA, CHRI , breaks down updated CMS guidance for reporting virtual clinic visits and other telehealth services rendered at on- and excepted off-campus provider-based departments.
Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , describes simple actions you can take to show appreciation for providers and make education unobtrusive during the novel coronavirus (COVID-19) public health emergency.
Recently published CMS guidance clarifies billing requirements for services rendered via telecommunications technology during the public health emergency. Valerie Rinkle, MPA, CHRI , breaks down the updated guidance as it applies to outpatient services provided at alternative care sites such as patient homes.
Physicians and facilities use the same codes to report E/M levels for ED services, but follow different rules. Outpatient coders must be able to assign E/M codes for both physicians’ work and resources utilized by the facility during emergency visits.
CMS recently issued a major update to frequently asked questions (FAQ) on COVID-19 fee-for-service billing issues. The bulk of the new FAQs concerns hospitals and the ability to invoke various waivers in order to deliver services to patients in their homes using telecommunications technologies.
Abnormalities in the brain and spinal cord can influence all body systems. Therefore, it is not surprising that diagnosis codes for neurologic disorders are widespread throughout the ICD-10-CM manual.
The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for the novel coronavirus (COVID-19). This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities.
Learn how revenue cycle professionals have managed the constant change and monitored for potential problem areas brought on by the public health emergency.
CMS on April 30 released an interim final rule with regulatory relief for hospital outpatient departments. In this article, Kimberly A. Hoy, JD, CPC , reviews Medicare provisions that allow outpatient departments to bill services at alternate locations during the novel coronavirus (COVID-19) public health emergency.
Review up-to-date novel coronavirus (COVID-19) documentation tips, ICD-10-CM and CPT coding guidance, and advice for ensuring billing compliance during the public health emergency.
Physician practices have started reopening to patients but are not expecting a return to normal anytime soon. They continue to struggle with staffing shortages and lost revenue due to COVID-19 restrictions.
Coding audits are commonly used to determine the need for focused coder education and training. Learn about key considerations for conducting coding audits and summarizing significant audit findings.
PEPPER is an acronym for the Program for Evaluating Payment Patterns Electronic Report . The PEPPER was originated by the Hospital Payment Monitoring Program (HPMP) and Quality Improvement Organizations.
The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for the novel coronavirus (COVID-19). This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities.
For FY 2021, CMS projects the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 2.5%. Proposed changes in uncompensated care payments, new technology add-on payments, and capital payments will decrease IPPS payments by approximately 0.4%, according to the proposed rule. Therefore, CMS estimates a total increase in overall IPPS payments of approximately 1.6%.
On May 11, CMS issued its inpatient prospective payment system (IPPS) proposed rule and policy changes for fiscal year (FY) 2021. The proposed rule includes ambitious policy changes showcasing CMS’ commitment to “transform the healthcare delivery system through competition and innovation while providing patients with better value and results.”
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary or excessive services, contributing to rising healthcare costs and the possibility of depleting Medicare funds.
The following questions were answered by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, director of HIM and coding for HCPro in Middleton, Massachusetts, and Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, lead instructor for HCPro’s Medicare Boot Camp®—Physician Services Version.
Read up on new CMS policies that expand COVID-19 care, ramp up diagnostic testing, and loosen restrictions on billing for telehealth services during the public health emergency.
All queries, regardless of their origin, are bound to follow the “ Guidelines for Achieving a Compliant Query Practice .” In order to ensure queries stand up to outside scrutiny and are effective, many CDI and inpatient coding leaders have put query audit practices in place for their departments as they bring on new team members.
Sepsis is a major challenge for patients, hospitals, and coders in America. Three articles first published online by the journal Critical Care Medicine give an update on trends in sepsis in the U.S. through Medicare beneficiary data collected between 2012 and 2018.
Practices that have experienced a shutdown or a near-shutdown during the COVID-19 national public health emergency need to adhere to state regulations for re-opening. In addition, they must consider the impact that re-opening would have on staff members and patients impacted by the pandemic.
Globally, millions of people have been infected by the novel coronavirus (COVID-19), according to the Centers for Disease Control and Prevention (CDC) . There have been hundreds of thousands of confirmed COVID-19 cases, and many thousands of deaths, just in the United States
Navigating Medicare’s rules for charging for ancillary services, bedside procedures, and supplies is no easy task. Get an expert perspective on how to apply the rules.
The Office for Civil Rights’ (OCR) enforcement discretion statement seems to open a whole new world of options for providers and patients. However, experts have warned providers that they can still get in a lot of trouble if they are not careful about how they use technology.
Providence St. Joseph Health, which cared for the first U.S. novel coronavirus (COVID-19) patient, is sharing how the health system has responded to the crisis.
On January 1, 2021, hospitals will enter a new world of price transparency. CMS put hospitals on track to face expanded price transparency requirements with a final rule released November 15, 2019.
Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a disease caused by the 2019 novel coronavirus, formally named COVID-19 . Recently, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern due to its sustained person-to-person spread within countries and across continental borders.
ICD-10-CM/PCS coding for severe and potentially fatal heart conditions such as aortic valve stenosis (AVS), heart failure (HF), and atrial fibrillation (AF) requires an in-depth understanding of anatomical terminology and clinical indications. Coders need to be able to select the most specific codes based on reported symptoms and the severity of the disease.
To enhance efforts to combat the opioid crisis in America, CMS policy allows for a new benefit under Medicare Part B concerning Opioid Treatment Programs.
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary or excessive services, contributing to rising healthcare costs and the possibility of depleting Medicare funds.
As with any new clinical documentation integrity (CDI) initiative, there are many possible starting points for outpatient CDI. Review advice from healthcare professionals at Trinity Health on how to successfully implement an outpatient CDI program.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes about conflicting documentation and how coders and clinical documentation integrity specialists can resolve inconsistencies in provider documentation to prevent claim denials.
Coding productivity held steady, but missing documentation and unanswered queries bog down coders, according to the results of our 2019 coding productivity survey
The fiscal year 2020 inpatient prospective payment system (IPPS) proposed rule threw gas on the population health fire when it proposed giving social determinants of health (SDOH) codes more weight as complications/comorbid conditions (CC).
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve.
Prevention of the flu is important as this illness can lead to hospitalization and even death. The CDC reports the hospitalization rate due to the flu is 2.7 per every 100,000 persons, and there is a 4.8% mortality rate due to influenza and pneumonia.
HCPro’s 2019 coding productivity survey showed that coding productivity held steady for 2019, but facilities continue to struggle with miscommunications between coding and CDI staff and unanswered physician queries.
If you aren’t yet confused by the site-neutral payment policy changes prompted by CMS apparently ignoring both Congressional intent and the American Hospital Association (AHA) and other impacted hospitals filing suit, you are likely to become so now.
One of the most vexing challenges that CDI specialists have is how to engage physicians to completely and precisely document their patients’ conditions and treatments in the language required by ICD-10-CM, which is essential to risk adjustment.
HIM directors’ and managers’ salaries made gains in some areas, but others may be falling behind, according to respondents of HCPro’s 2019 HIM director and manager salary survey.
Due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy.
As the cost of healthcare continues to skyrocket, payers are looking for ways to save and want to make sure that claims reflect correct information and that the care provided was clinically justified.
Although the dollar figures aren’t big, the Office of Inspector General’s (OIG) report on faulty chronic care management (CCM) billing should be concerning for physician practices billing these codes.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews updated policies in the 2020 Medicare Physician Fee Schedule final rule that will affect ICD-10-CM risk-adjustment reporting and documentation for facilities.
JustCoding’s sister publication, HIM Briefings, conducted a benchmarking survey to shed light on edit and denial management processes across the industry. Review findings from the survey to see how your organization compares to those across the industry.
In the 2020 Medicare Physician Fee Schedule (MPFS) final rule, CMS put a stamp of approval on its previous proposals to overhaul how medical practices will report office and outpatient E/M services in 2021.
According to ACDIS’ recent CDI Week Industry Survey , which included an extended section on CDI staffing practices, only 37% of respondents said they had HIM/coding backgrounds represented in their CDI departments.
Very few diagnoses have caused as much gnashing of teeth as sepsis has for inpatient coders and providers alike. Recently, the Centers for Disease Control and Prevention (CDC) has weighed in on the matter and is proposing coding changes , which, if adopted, will go into effect October 2020.
Let’s take a deep dive into the recently released coding guidance and documentation tips for these illnesses. Note that since vaping-related guidance and statistics are ever changing, this information is up to date as of October 2019.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation.
Review finalized changes to relative value units for office visits, new HCPCS codes for chronic care management and opioid treatment services, and future updates to the E/M reporting guidelines.
While many familiar ideas are often discussed—newsletters, tip sheets, organizational clinical definitions, and the like—not every physician responds the same way to the same educational techniques. Here’s what the CDI community had to say regarding this issue.
Vaping and vaping-related lung injuries have been in the news recently. The occurrence of serious and even fatal lung injuries associated with vaping have been reported this year with an increasing number of cases being reported over the last few months.
In today’s virtual environment, with its focus on flexible schedules, organizing the coding function requires consideration of time zones, team member skills, volume of work, and claim-processing schedules.
Let’s take a look at some common questions asked about MS-DRG optimization, and review how inpatient coding and documentation plays a significant role in the MS-DRG review process. Learning the ins and outs of this process will ensure that your facility remains educated and compliant on this topic.
Now that October 1 has passed, we are in full swing with the updated ICD-10-PCS code set for fiscal year (FY) 2020. There are now 77,559 total ICD-10-PCS codes for us to work with.
Perhaps the most momentous Quality Payment Program (QPP) news in the 2020 Medicare Physician Fee Schedule proposed rule is the Pathways version of the Merit-based Incentive Payment System (MIPS)—but that’s not happening until 2021.
With much of the coding workforce working remotely, the inpatient coding manager must implement some control mechanisms to ensure the distractions at home are not interfering with the quality and quantity of work expected from the staff. In this article Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, gives suggestions on the various ways to monitor your remote coding staff, including tips for conducting coding reviews. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
I can teach CDI to anyone. Just get the providers in a room with me; they don’t even have to be willing participants. While I have heard many times that physicians only listen to other physicians, I believe my success has less to do with the initials at the end of my name and more with the fact that the CDI cause is just, and I’m passionate when I teach.
In August, CMS released the fiscal year (FY) 2020 IPPS final rule , which affects approximately 3,300 acute care hospitals and applies to discharges occurring on and after October 1, 2019. With the massive amount of information covered in the final rule, this overview will pinpoint some of the most important aspects for inpatient coders and hospitals to review.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Internal audits can reveal inconsistencies in provider documentation and coding, reporting errors, and fraudulent billing practices. Review internal auditing basics and advice from regulatory experts on how to effectively educate providers on audit findings. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Since we have already covered an overview of the final rule and the updates to the ICD-10-CM/PCS code set, for this BCCS article, let’s take a look at some of the key financial updates that hospitals should be aware of.
