Allen Frady, RN, BSN, CCS, CCDS , and Gwen S. Regenwether, BSN, RN , combat coders’ and clinical documentation improvement (CDI) specialists’ querying bad habits, and show how to support productivity and revenue flow for the facility.
For years, coding professionals have been tasked with ensuring that bills for Medicare patients include the proper elements of the diagnosis-related group (DRG) in order to try to accurately show a patient’s severity, but, as Robert S. Gold, MD , writes, there is much more to coding than DRG maximization.
Approximately 800 hospitals across the country that perform inpatient total hip and knee joint replacements will be required to participate in the latest value-based payment initiative launched by CMS, the Comprehensive Care for Joint Replacement (CJR) model, which becomes effective April 1.
To charge or not to charge--that is the question. Determining whether a hospital can charge for certain services and procedures provided at a patient's bedside is a task often fraught with confusion and uncertainty.
The new ICD-10 system and its inherent errors, especially in ICD-10-PCS, has provided fertile ground for honest errors. But for this article, I'm going to talk about the other side of the coin, where new codes or descriptions of codes come out, often with inadequate definitions or directions, and people make up reasons to try to rook the system and bilk Medicare?that is, until enough caregivers get caught or advice comes out to squelch the "experts" who want to help you get denials by the hundreds or get hassled by Recovery Auditors.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, looks at the definitions for primary, principal, and secondary diagnoses and how to determine them from provider documentation.
Denials are on the rise for certain diagnoses, procedures, and regulations. Sarah C. Mendiola, Esq., LPN, CPC, outlines steps providers can take to reduce denials by focusing on certain documentation details.
Even before ICD-10, unclear definitions for certain diagnoses and procedures led to confusion for coders trying to interpret physician documentation. Robert S. Gold, MD, writes about conditions in the new code set that could lead to potential risks for providers.
The government recently approved changes for physician payment systems. Is your clinical documentation improvement (CDI) team ready to tackle these challenges? More importantly, are your physicians ready?
Gwen S. Regenwether, BSN, RN, and Cheree A. Lueck, BSN, RN, discuss how the clinical documentation improvement department at their facility operates and their process for conducting a baseline audit and determining query rates across specialties.
Gwen S. Regenwether, BSN, RN, and Cheree A. Lueck, BSN, RN, look at how to use audit and query rate information to improve documentation at a facility and how to encourage continuing education and collaboration going forward.
Joel Moorhead, MD, PhD, CPC, writes about details for spinal conditions for coders to consider when choosing the most accurate ICD-10 codes for diagnoses and procedures.
Sometimes you see documentation in the medical record entered by one physician and then by nobody else. Sometimes you see documentation entered by one physician and copy/pasted by everyone else.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, reviews updates in Coding Clinic about coding orthopedic procedures in ICD-10-PCS, coma data in ICD-10-CM, and both cardiovascular procedures and diagnoses.
Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CIC, an HIM director for a health system in North Carolina, provides her wish list for her department and coders, including thoughts on implementing a CDI program, working with payers, and hiring staff.
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP, writes about the importance of tracking venous thromboembolism at hospitals and how to ensure physician documentation includes the correct level of detail to capture it.
Q: We recently had attending physicians send back queries with responses by the physician assistant (PA) or nurse practitioner (NP) who documented for them. Is it acceptable for a PA or NP to answer queries after the patient is discharged?
The Hospital Readmissions Reduction Program (HRRP) is a CMS pay-for-performance program that links the amount hospitals are paid to risk-adjusted readmission rates. Measures included in the program are claims based, which simply means that the ICD-10 codes we submit on our claims for payment are also used to assess our performance; our performance then impacts our payment.
Sherry Corsello, RHIT, CPC, writes about how to ensure consistency and reliability of records in ICD-10 and what providers can do with the more accurate data the code set will give them.
