Medicare finalized a care management service for chronic pain management (CPM). Effective January 1, CPM services can be reported by a wide range of providers, including primary care practitioners.
Clinical quality measures are tools used by healthcare professionals to measure or quantify processes and outcomes. Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ, describe documentation elements that affect quality metrics and how to incorporate them into an audit workflow.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC , defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
Acute hospital care at home is reimbursed the same as if the patient was physically an inpatient in a hospital, with the same documentation requirements, quality measures, and medical necessity guidelines. Learn how strengthening CDI's role in these programs can help support their success.
CMS confirmed in the 2023 Medicare Physician Fee Schedule final rule that it will adopt the framework of the revised AMA E/M guidelines, including payment based on medical decision-making (MDM) or time, effective January 1, 2023. Laura Evans, CPC, explains how the agency will diverge from the AMA on some points, however.
Quality metrics are complex, and it takes deep knowledge to understand their intricacies. Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ , describe commonly overlooked documentation elements that can affect quality metrics and outline how to incorporate these elements into an audit workflow.
Lena Wilson, MHI, RHIA, CCS, CCDS , takes a deep dive into the CDI/coding reconciliation process and outlines tips that coders and CDI professionals can apply to improve this process.
The Office of Inspector General (OIG) released a report in October to assess the results of 12 Medicare hospital and identify CMS’ actions as a result of OIG recommendations made in those audits.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC , defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
Kathy Shumpert, MSN, RN, CCDS, writes about the evolution of the denials and appeals process at her facility and discusses tactics to improve communications and efficiency.
A coder’s practice should check its telehealth claims against the information in the recent Office of Inspector General data brief on telehealth services, healthcare attorneys advise. Julia Kyles, CPC, reviews the September 2 report, which contains findings and program integrity measures for telehealth services.
Respiratory failure occurs when the body is unable to provide oxygen to or remove carbon dioxide from the body. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down documentation and ICD-10-CM coding for acute and chronic respiratory failure.
A properly calibrated audit tool is key to uncovering educational opportunities for coding and CDI professionals. Dawn Valdez, RN, LNC, CDIP, CCDS, outlines questions for determining an audit focus and for querying providers when documentation is insufficient to support medical necessity.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic. Julia Kyles, CPC, explains the significance of using the OIG’s data brief and offers tips to adhere to compliance guidelines.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic.
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
Audits are crucial to helping CDI and coding teams stay up to date with the fast pace of medicine and continual changes to coding guidelines. Dawn Valdez, RN, LNC, CDIP, CCDS , writes about best practices for auditing and application of audit findings .
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
