An upcoming audit reviewing Medicare inpatient hospital billing for sepsis underscores the critical importance of accurate coding and clinical validation. With guidance from Leigh Poland, RHIA, CCS, CDIP, CIC , coders can help prevent costly coding errors, reduce the risk of audits, and ensure hospitals are appropriately reimbursed for the care they provide. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Acute respiratory distress syndrome presents a significant clinical challenge due to its rapid onset, high mortality rate, and complex management. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , delves into the comprehensive aspects of ARDS to show how coders, alongside healthcare providers and CDI specialists, play an essential role in reporting the complete picture of the condition.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , invites a deeper understanding for diagnosing and documenting acute renal failure and any other related diagnoses—before exploring the plethora of denial strategies medical staff may face. Not to worry as there are opportunities for successful appeals!
Review a recent OIG audit which found that Medicare payments for inpatient claims assigned with MS-DRGs 207 and 870 did not fully comply with Medicare requirements, resulting in $79.4 million being improperly paid to hospitals.
With guidance from three certified medical professionals, CDI specialists and coders can learn how to fight against the overwhelming tide of clinical validation denials by promoting strong documentation, capturing clinical pictures with appropriate codes, and justifying treatment plans.
Denials continue to be a pain point and significant challenge for every hospital across the nation, but Angelica Cage, MBA, BSN, RN, CCDS, CCS, CDIP , provides denial-proofed queries to show how establishing a diagnosis that is strongly supported by the available clinical evidence can reduce or eliminate clinical doubt with respect to the treated condition.
Whether the discussion is about reimbursement, quality metrics, patient outcomes, or CC/MCC capture rates, the whispers of risk adjustment have grown to a roar. Jennifer Brettler, DO, FACP, CHCQM-PHYADV , reveals just how much risk adjustment plays a role in documentation and coding integrity, impacting patient care.
Our experts answer questions on the new ICD-10-CM serotonin syndrome code, key takeaways for documenting and supporting malnutrition diagnoses, and appropriate circumstances for reporting codes from ICD-10-CM subcategory E66.8- (other obesity).
Successfully managing inpatient stay denials should begin long before they occur and depends on having excellent case management, CDI, and coding departments. Although these departments have differing duties, Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , shows how they all play a part in ensuring that the final coded data is compliant and accurate.
The majority of U.S. healthcare organizations struggle with denials and underpayments in all care settings, making it difficult to keep up with a meaningful manual appeals process. Learn how coding professionals can leverage technology to accurately capture and validate clinical data, ensuring proper coding and documentation while reducing the likelihood of denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With advice from three certified medical professionals, CDI specialists and healthcare providers can develop relationships that foster a culture of collaboration and continuous improvement in documentation and coding practices.
The majority of U.S. healthcare organizations struggle with denials and underpayments in all care settings, making it difficult to keep up with a meaningful manual appeals process. Learn how coding professionals can leverage technology to accurately capture and validate clinical data, ensuring proper coding and documentation while reducing the likelihood of denials.
The decision to implement AI in one’s health system is no small matter, but Katie Parsley, MSN, RN, CCDS, CPHQ, a CDI manager at Providence Health and Services in Oregon, shows how technology solutions employed at her organization have had an overall positive impact on clinical accuracy, prioritization, querying, and the efficiency of CDI staff.
Our experts answer questions on linking cellulitis and diabetes, coding COPD and associated conditions, and applying clinical criteria guidelines for sepsis.
With advice from three certified medical professionals, CDI specialists and healthcare providers can develop relationships that foster a culture of collaboration and continuous improvement in documentation and coding practices.
Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP, explores common reasons for sepsis-related denials, offers strategies for effective documentation and coding, and presents approaches to successfully appeal these denials.
Amid the myriad of conditions and diseases, probable catheter-associated bloodstream infections emerge as a focal point for clinical intervention and revenue cycle efficiency. Pooja Patwal, MBBS(MD), CCS, CDIP, CHCQM , explores how capturing accurate ICD-10 codes for probable BSIs is paramount for healthcare facilities striving for excellence in patient outcomes.
Chronic conditions pose significant challenges to individuals and healthcare systems alike, often leading to reduced quality of life, increased healthcare costs, and rise in mortality rates if left unmanaged. Proper documentation of chronic conditions, however, can help facilitate communication, coordination, and continuity of care for patients from healthcare providers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Gain unique and fresh insights from clinical documentation integrity professionals in unique settings to help you strengthen your organization’s denials management efforts.
