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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
While it is essential to receive continuing education on ICD-10-CM/PCS code selection, it is also important to stay current with payment system changes and industry news. What are the regulatory changes that will affect inpatient coders in fiscal year (FY) 2020?
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.
According to the Fourth Universal Definition of Myocardial Infarction (2018), “The clinical definition of myocardial infarction denotes the presence of acute myocardial injury detected by abnormal cardiac biomarkers in the setting of evidence of acute myocardial ischemia.”
While the calendar year 2020 OPPS proposed rule is shorter than in prior years (819 pages for the display version), the proposed policies therein pack a punch and may be thought of as a new day dawning for the future of hospital services.
CMS proposed a new framework for the Merit-based Incentive Payment System (MIPS) intended to make the transition to value-based care easier for physicians. Read up on the proposed framework, MIPS Value Pathways (MVP), and its potential impact on patients and providers beginning in 2021.
The 2020 Medicare Physician Fee Schedule proposed rule includes significant documentation and payment changes for outpatient office visits reporting using E/M codes 99202-99215. Beginning in 2021, these proposed updates could add billions of dollars to the national E/M revenue stream.
While it is essential to receive continuing education on ICD-10-CM/PCS code selection, it is also important to stay current with industry news. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , reviews inpatient reporting and guideline updates for fiscal year 2020. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Even if a hospital is not a teaching hospital, it may have services that require National Clinical Trial (NCT) reporting. It is logical for revenue integrity leadership to own this issue, but an explanation of the requirements for NCT reporting should be shared with all staff within the revenue cycle so there is a better appreciation of the fact that clinical trial billing rules apply more broadly than merely just to research or clinical trial studies.
Before starting an ambulatory or outpatient clinical documentation improvement (CDI) program, those tasked with the project must first create some universal definitions, so everyone is on the same page and speaking the same language.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , explains why physicians may feel that coding and CDI professionals are asking too much and offers potential solutions to ease workplace tensions.
Medicare appropriate use criteria (AUC) requirements, currently in a voluntary testing period, will become mandatory starting January 1, 2020. Denise Williams, COC, CHRI , shares insight and analysis on AUC reporting requirements to help facilities prepare for what’s to come.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve. Review advice from experts on improving internal processes for dealing with commercial audits.
Before starting an ambulatory or outpatient CDI program, those tasked with the project must first create some universal definitions so everyone is on the same page and speaking the same language.
CMS recently released two quarterly updates effective July 1: Medicare Claims Processing Transmittal 4313 , which is the July update to the OPPS, and Medicare Claims Processing Transmittal 4314 , which is the related July update to the Integrated Outpatient Code Editor (I/OCE) Specifications, Attachment B.
This summary, organized by major diagnostic category (MDC), highlights some of the changes to the IPPS proposed rule affecting MS-DRG and ICD-10-CM/PCS code assignment.
Correct documentation and coding are key to accurate reimbursement, but according to the Office of Inspector General, organizations aren’t hitting the mark on either when billing for inpatient rehabilitation facility (IRF) services.
CMS recently released quarterly updates to the OPPS and Integrated Outpatient Code Editor (I/OCE), effective July 1. Judith Kares, JD , summarizes key coding and billing policy updates, including changes to APCs, status indicators, revenue code changes, and more.
A May report from the Office of Inspector General (OIG) found that some physician practices were at the root of basic coding errors that caused federal overpayments. Although the Essence audit was small, the findings have significant implications for physician coders.
Learn how ICD-10-CM coding accuracy, specificity, and compliance impacts provider performance in each of the four performance categories under the Merit-based Incentive Payment System (MIPS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, presents a review of MS-DRG basics to ensure that inpatient coders have a thorough understanding of MS-DRGs’ intricacies, thus perfecting assignment and reimbursement accuracy.
At the beginnings of inpatient coding and CDI, we had books like DRG Expert and Excel-based programs for MS-DRG selections. More than 10 years later, vendors are offering web-based technologies that use artificial intelligence and machine learning to make us even more productive in both coding and CDI. The real question, however, is how we can best leverage those technologies.
Valerie Rinkle, MPA, CHRI, covers important proposals found in the fiscal year (FY) 2020 IPPS proposed rule, including coding updates, new technology payment changes, and increases to low wage index hospitals.
The role of the coder has transitioned over the past few years to one that is more auditing-heavy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes how to effectively perform internal audits and educate providers on coding best practices.
Anthem announced that it may reject claims that contain a subsequent E/M service that’s linked to the same diagnosis as an earlier E/M encounter. Learn what Anthem’s modifier -25 policy means for providers and physician coders.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews the background of MS-DRGs, as frequently revising MS-DRG basics will ensure that inpatient coders have a thorough understanding of the MS-DRG intricacies, thus perfecting overall assignment and reimbursement accuracy.
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about E/M code changes implemented this year and changes for implementation over the next two years.
Providers will find significant leeway in how they can report advance care planning (ACP) services for physicians given CMS’ open-ended coding requirements. Review potentially confusing CPT time rules and other obstacles that may be holding back providers from engaging in ACP services.
Laura Legg, RHIT, RHIA, CCS, CDIP, takes a look at some common questions asked about MS-DRG optimization and reviews how inpatient coding and documentation plays a large role in the process.
