These days, the healthcare industry is all about the numbers, especially as pay-for-performance becomes more common. Lawrence L. Sanders, Jr., MD, MBA, and Simone R. Gravesande, RN, BSN , review how APR-DRGs work and why all coders should understand them.
The accuracy and completeness of coded data can potentially affect physicians more as the healthcare industry becomes increasingly transparent to consumers. William E. Haik, MD, FCCP, CDIP, Timothy Brundage, MD, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Cathy Testerman, CCS, EMT, and Donna Walker-Thomas, MBA, RHIA, CPC, CMA, review how coded data relates to physician profiling and offer tips for engaging physicians in documentation improvement.
Although coders and billers don’t play a role in determining whether condition code 44 is appropriate, they certainly ensure correct billing of the code. Deborah K. Hale, CCS, CCDS, and John Zelem, MD, FACS, review the requirements for condition code 44 and when coders should report it.
Nearly 75% of participating hospitals nationwide with RA activity reported receiving at least one underpayment determination, according to the AHA RACTrac survey, fourth quarter 2012, released in March. Sixty-nine percent of hospitals with underpayment determinations cited incorrect MS-DRG as a reason for the underpayment.
The three-day payment window has been wrought with compliance challenges since its inception. In January, CMS updated the policy to provide additional clarification.
Distinguishing between clinical and coding significance is often confusing. Joel Moorhead, MD, PhD, CPC, discusses how coders should differentiate between the two.
The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on. Andrea Clark, RHIA, CCS, CPC-H, CEO, Debbie Mackaman, RHIA, CHCO, and Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , explain how coders and their organizations can benefit from internal audits.
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
Although coders and billers don't play a role in determining whether condition code 44 is appropriate, they most certainly ensure correct billing of the code.
Being audited is rarely fun. After all, you're probably going to lose money, face a fine, or both. More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on.
Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
Evaluation and management (E/M) coding is incredibly subjective. Two coders can look at the same documentation and choose two different E/M levels and both will be able to justify their choice. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer , Lori Owens, RHIT, CCS, and Deborah Robb, BSHA, CPC, discuss how electronic medical records can complicate E/M coding even more.
Recovery Auditors are currently performing prepayment MS-DRG validation and coding reviews of MS-DRG 312 (syncope and collapse). Ralph Wuebker, MD, MBA, and Stacey Levitt, RN, MSN, CPC, discuss the scope of the new reviews and what coders need to look for in documentation of syncope.
The advent of electronic media is slowly but surely changing the way we access information. Hospitals and physicians are transitioning from paper and hybrid medical records to EHRs. Estimates indicate that nearly half of all Internet users send or receive email daily, according to EzineArticles.com .
Researcher Bill Rudman, PhD, RHIA, says he didn't fully understand the implications of codes that coders assign until he was sitting around a table with several criminal justice officials who said that coded data helps reduce violent crimes and recidivism.
Coders are under constant stress and pressure. They must remain incredibly focused and pay attention to detail regularly. Lois E. Mazza, CPC, discusses why coders need to think about their health.
MS-DRGs won’t change much in the first year after the transition to ICD-10, but hospitals still need to understand the details of the transition. Janice Bonazelli and Dwan Thomas Flowers, MBA, RHIA, CCS, explain how to use the draft ICD-10 MS-DRG Definitions Manual to prepare for MS-DRGs in ICD-10.
One of the major changes to the 2013 CPT ® Manual is the replacement of the term "physician" with "physician or other qualified healthcare professional" in a wide range of codes. Marie Mindeman and Andrea Clark, RHIA, CCS, CPC-H, discuss how this change affects code assignment.
