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.
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.
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.
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.
Coding and CDI programs can take many approaches to manage denials, whether they focus on physician documentation education, have a team member dedicated to writing appeals, or anything in between.
Coding for conditions complicating pregnancy and delivery can be challenging, given the number of factors that influence maternal and fetal health. This article details ICD-10-CM coding for cervical incompetence, in vitro fertilization (IVF), and postpartum care complications.
Tackling reporting errors early on is an essential component of denials management. Leyna Belcher, MSN, RN, CCDS, CCDS-O , describes strategies that coding and billing professionals can employ to reduce claim denials and increase the success rate of appeals.
Inpatient coders and CDI specialists are usually familiar with ICD-10-CM coding for diabetes mellitus and Cushing’s syndrome. However, they may need a refresher on ICD-10-CM coding for less common endocrine disorders. This article breaks down endocrine anatomy and physiology, and ICD-10-CM coding for thyroid, parathyroid, adrenal, and pineal irregularities.
According to Deanne Wilk, BSN, RN, CCDS, CDIP, CCDS-O, CCS, patient safety and quality of care are forerunning concerns for organizations today, and hospitals need to examine how and when they evaluate that quality of care in order to remain ethical and compliant.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CACO, CAC, reviews findings from a recent Office of Inspector General audit of claims for neurostimulator implantation surgeries and their implications for coders.
