For FY 2022, CMS continues to expand inpatient access to cutting edge health care technologies by increasing the additional payments designed to cover their development costs and streamlining applicable FDA approval processes.
Since the start of the pandemic, HIM, CDI, and coding professionals have focused on understanding acute respiratory distress syndrome (ARDS) as a manifestation of COVID-19.
You may wonder why an article about the coding of Hierarchical Condition Categories (HCCs) in the outpatient wound care setting is appearing in an inpatient periodical. When I first approached this topic, I focused on the outpatient wound care setting. But the more I thought about it, I realized this topic is pertinent for inpatient coders.
CMS recently released the 2022 Medicare Physician Fee Schedule proposed rule, which introduces new guidelines for reporting split/shared visit services. Julia Kyles, CPC , analyzes how the changes would impact physician practices.
CMS recently released the fiscal year (FY) 2022 IPPS final rule which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
Earlier this year, the Office of Inspector General (OIG) added a new OIG Work Plan item for reporting E/M services with minor surgical procedures. Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , reviews appropriate use of modifier -25 for separately identifiable E/M services.
HIM and coding directors and managers report some gains in salary but have fewer staff in the department with no plans to hire new staff, according to the results of an HCPro’s 2021 HIM director and manager salary survey. Although directors’ and managers’ salaries and benefits appear to have weathered the financial effects of the COVID-19 pandemic, HIM departments may continue to see resources stretched thinner than ever.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
With most patient charts now housed in EHRs, technology has become a standard part of the healthcare industry. Growing technological adoption, however, means physicians spend an increasing amount of time on computers and using technology.
The kidneys filter waste and excess fluid from the blood. As kidneys fail, these wastes build up. The symptoms of chronic kidney disease (CKD) generally develop slowly and aren't specific to the disease. Often, there are no noticeable symptoms, and the condition is noted incidentally from a diagnostic testing, or the symptoms first appear once the disease course has reached significant impairment.
In this note, we will review proposed changes to quality programs for inpatient acute and long-term hospital services, and changes to address existing inequities and prevent future inequities in the delivery of these services, including significant improvements to data collection and analysis capabilities.
While technological solutions and electronic health records have made leaps and bounds over the past years in the inpatient setting, there still seems to be much lacking on the outpatient side. Learn how to leverage existing technology to track Hierarchical Condition Category capture and other coding metrics.
In April, CMS released the fiscal year (FY) 2022 IPPS proposed rule. The rule contains proposed payment changes under Medicare Part A for covered inpatient stays in short-term acute care hospitals and inpatient stays in long-term care hospitals.
National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) can throw a wrench in the Medicare billing process, delaying appropriate revenue. Learn how to apply recent guidance and best practices to resolve challenging edits.
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , summarizes findings from recent Office of Inspector General audits that highlight improper billing of high-level inpatient stays. He also outlines steps hospitals can take to prevent billing errors due to upcoding.
CMS withdrew the split/shared and critical care sections of the Medicare Claims Processing Manual and announced its intent to update coverage policies for these services. Prepare for changes to come by reviewing documentation, CPT coding, and billing guidance for split/shared and critical care services.
CMS offers hospitals some breathing room to recover from the effects of the COVID-19 pandemic in the 2022 IPPS proposed rule. Review proposed updates to complication/comorbidity (CC) and major CC classifications, and a proposed new MS-DRG rate-setting method aimed at alleviating hospital burden.
With the inpatient-only (IPO) list set to be phased out, HIM departments need to prepare for the larger operational and financial impacts. Consider how these changes will affect your organization.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO, looks at the implications of a recent OIG brief on how Medicare Advantage organizations could use national provider identifiers (NPI) to monitor for fraud, waste, and abuse.
Laura Evans, CPC, and Julia Kyles, CPC, break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
The agency is proposing methods to alleviate burden on hospitals that have been under strain for the past year, while also asking for feedback that may shape future data reporting and rate-setting.
The monetary value of outpatient clinical documentation integrity (CDI) programs is increasing dramatically year after year. Read about steps your facility can take to create and maintain a successful outpatient CDI program.
Monica Tyiska, MBA-PM, RHIA, CCS, CPC, CPMA, CHA, OHCC, CCP-P, offers advice for how organizations can improve hiring practices to ensure candidates from diverse backgrounds that represents the community are brought in.
Hierarchical Condition Categories (HCC) are used to represent risk scores for patients on Medicare Advantage plans. Learn why it’s important for organizations to understand how HCCs are used across settings.
It’s always been easy to show financial return on investment for inpatient CDI endeavors, but the monetary value of outpatient programs is increasing dramatically year after year, making outpatient CDI reviews more attractive to many healthcare organizations.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how facilities can create internal guidelines and point systems for determining E/M level section.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Allen Frady, RN, BSN, CCS, CRC, CCDS, describes steps that coding and clinical documentation integrity managers can take to improve quality metrics and hold staff accountable for reporting errors.
About 1% of children in the U.S. suffer from chronic malnutrition, according to John Hopkin’s Medicine. In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, breaks down ICD-10-CM coding and documentation requirements for malnutrition.
Regular monitoring and internal auditing are critical to ensure compliance throughout the revenue cycle and protect revenue integrity. Consider the different strategies that can be applied to documentation and chart audits, coding audits, and more.
Let’s face it: Our organizations are under tremendous scrutiny. As the healthcare dollar shrinks, all payers strive to minimize patient care expenses to maintain profit margins.
Strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
It’s common to see CDI job listings that require applicants to be registered nurses. Often an RN credential is not listed as being “preferred,” but required. There are risks, however, with only seeking candidates from this one background.
Ischemic heart disease has a multifactorial etiology and can be prevented from developing in populations primordially and in individuals at high risk by primary prevention.
The mid-revenue cycle is rife with possibilities to lose earned, appropriate revenue. Learn how to identify common weaknesses and deploy coding and technology to avoid revenue loss.
Supporting accurate Hierarchical Condition Category (HCC) capture is essential to success under the growing number of risk-adjusted payment models. With their strong knowledge of coding and documentation guidelines and insight into emerging trends, coders are a key part of that strategy.
Though the adoption of outpatient CDI has been growing steadily over the years, it’s not always easy to prove the return on investment for such efforts.
In 2005, the International Pediatric Sepsis Consensus Conference published definitions for sepsis, severe sepsis, and septic shock. Sepsis among children is defined as systemic inflammatory response syndrome (SIRS) associated with suspected or proven infection.
Facilities that are not leveraging CDI efforts for denials management and tracking denials as a key performance indicator (KPI) should consider doing so. Denials are the framework for identifying gaps in provider documentation and are a surefire approach to tailoring physician education that is meaningful.
Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. It’s more important than ever as the COVID-19 pandemic continues to drain hospital resources, but with HIM departments already stretched thin, it’s also more difficult than ever.
