Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.