Hospitalists coded a significantly higher proportion of Medicare beneficiaries as high severity compared to non-hospitalists, according to a study published in the Journal of the American Medical Association Health Forum .
CMS is proposing to hit pause on major changes to MS-DRG designations while considering numerous changes to quality reporting and value programs, according to the fiscal year 2023 IPPS proposed rule. Read up on CMS’ proposed updates, which will impact inpatient hospitals beginning October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Revenue leakage can be caused by a number of factors including late filings, inconsistent documentation, and inaccurate coding. Fran Jurcak, MSN, RN, CCDS, CCDS-O , describes proactive strategies that coding professionals can use to address mid-revenue cycle leakage.
As a result of the pandemic, delivering consistent, quality CDI education has become more challenging. My hospital has been no exception, and although adapting has not been easy, it is doable.
CMS is proposing to hit pause on major changes to MS-DRG designations while considering numerous changes to quality reporting and value programs, according to the fiscal year 2023 IPPS proposed rule. Read up on CMS’ proposed updates, which will impact inpatient hospitals beginning October 1.
Approximately 37.3 million Americans have diabetes, and nearly 20% of them don’t know they have it, according to the Centers for Disease Control and Prevention. Review the signs and symptoms of diabetes and guidelines for reporting the condition in ICD-10-CM.
Reviewing a sample of claims for clinical validity and coding accuracy can seem like a daunting task. Kaitlin Loos, RN, BSN, CDI auditor, and Molly Siebert, RHIA, CCDS, CDI specialist, describe their individualized review processes.
Coding managers should not assume that they can review every coding guideline, Coding Clinic , or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the fiscal year (FY) 2023 IPPS proposed rule on April 18, with proposals for the annual ICD-10-CM/PCS code update and increases to hospital payment rates. The rule also introduces new quality measures aimed at advancing health equity and improving maternal health outcomes.
Inpatient coders must be familiar with different types of denials such as those due to clinical validity concerns. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , outlines components of a clinical validation denial and tools used to craft a clinical validation appeal.
Nancy Treacy, MPH, RHIA, CDIP, CCS , describes her team’s experience implementing a streamlined audit process and offers advice to help others do the same. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Monitoring coding accuracy enables coding managers to spot error trends that could result in claim denials. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , describes two methods used to calculate coding accuracy based on a sample of claims.
A recent audit conducted by the Office of Inspector General (OIG) projected that hospitals received $47.8 million in net overpayments from January 2018 through July 2019 for Medicare Part A claims that did not meet national requirements or contractor specifications for bariatric surgery.
Inpatient coders must be familiar with different types of denials such as those due to clinical validity concerns. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , outlines components of a clinical validation denial and tools used to craft a clinical validation appeal.
Nancy Treacy, MPH, RHIA, CDIP, CCS , describes her team’s experience implementing a streamlined audit process and offers advice to help others do the same.
Electronic health records (EHR) hold all the important information about patients’ medical histories and demographics. Historically, however, they have tended to only include one indication of gender: the gender a patient was assigned at birth.
Anxiety disorders are the most common mental illness in the U.S., according to the National Institute of Mental Health Statistics. Shelley Safian, PhD, RHIA, CCS-P, COC, CIC , breaks down ICD-10-CM coding for common types of anxiety disorders and psychotherapy treatments used to manage them.
It is estimated that as many as 1 in 500 adults may suffer from a cardiomyopathy, according to the Centers for Disease Control and Prevention. Review documentation considerations and ICD-10-CM coding for different types of cardiomyopathies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released three ICD-10-PCS codes, effective April 1, for the administration of fostamatinib (Tavalisse®)—an oral spleen tyrosine kinase inhibitor used to treat adults with low platelet count due to chronic immune thrombocytopenia.
Mechanical ventilation is a life-saving intervention used for acutely ill patients who cannot breathe on their own. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , evaluates medical terminology used to describe mechanical ventilation and breaks down ICD-10-PCS coding for this procedure.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how to use Office of Inspector General audit reports to identify areas at risk for noncompliance and how to organize targeted internal reviews.
Physician documentation of heart failure must specify the type and severity of the illness to apply the most accurate code. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , breaks down clinical documentation and ICD-10-CM coding for four types of heart failure.
Patients are often admitted for acute conditions and experience additional issues affecting their care and treatment plan during the encounter. Ashayla Stephens, MHA, RHIA, CCS , and Audrey Howard, RHIA , describe the process of validating multiple diagnoses documented within the health record. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent audit conducted by the Office of Inspector General (OIG) found that Tufts Health Plan Inc. (Tufts) received at least $3.7 million of net overpayments from 2015 to 2016 for incorrectly submitting selected high-risk diagnosis codes.
The primary purpose of CDI work is to review medical records to increase the accuracy and specificity of provider documentation. Review the primary responsibilities of a CDI specialist including documentation review, querying, and physician education.
Acute kidney injury (AKI) is a sudden and temporary loss of kidney function, while acute tubular necrosis (ATN) is a kidney injury characterized by acute tubular cell injury and dysfunction.
Organizations may opt to measure productivity using several methods, such as number of charts coded per day or per month, based on their needs, service lines, and other considerations. Some organizations use different productivity metrics for specific settings or account types.
Chapter 19 of ICD-10-CM includes codes for various types of injuries, poisonings, and other consequences of external causes. Review integumentary anatomy and ICD-10-CM coding for burns and superficial injuries.
CDI specialists must be able to apply both clinical and coding knowledge in order to discern relevant clinical conditions, and they must be able to analyze the quality of provider documentation and identify any gaps or inconsistencies in information between the health record and the associated data.
The Office of the Inspector General (OIG) recently announced it will conduct statewide reviews to determine whether hospitals complied with Medicaid billing requirements when assigning severe malnutrition diagnosis codes to inpatient hospital claims.
Q: Our coding team has been having trouble understanding how to correctly report diabetes mellitus (DM) “with” other conditions in ICD-10-CM. Can you provide some guidance on this issue?
One of the biggest components of a leader’s role is to track, trend, and report on the department’s performance. Learn strategies for balancing priorities and time constraints and presenting key performance indicators to leadership.
The CMS hierarchical condition category (CMS-HCC) methodology recognizes specific combinations of diseases as well as the effect of disease processes as related to different settings of care. These metrics are important to understand in order to ensure proper reimbursement, even within the inpatient coding and CDI sector.
Due to the complex nature of sepsis, some cases require querying the provider prior to assigning ICD-10-CM/PCS codes. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , breaks down inpatient coding and querying for sepsis.
Computer-assisted coding (CAC) technology analyzes healthcare documentation and selects codes based on specific phrases and terms. Review the pros and cons of using this software to perform inpatient coding and billing functions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and ICD-10-CM documentation requirements for traumatic fractures to resolve the coding challenges.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes that it’s not unusual for an outpatient coder to advance their career by diving into inpatient coding. When deciding to learn about ICD-10-PCS, it’s important to first understand the basics and compare and contrast ICD-10-PCS and CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Inpatient coders know that clinical indicators for certain conditions frequently require greater completeness or specificity in ICD-10-CM for which a concurrent or retrospective query is often required. This article will review clinical indicators and query opportunities for common respiratory conditions such as pneumonia, respiratory failure, and asthma.
One of the biggest components of a leader’s role is to track, trend, and report on the department’s performance. Key performance indicators can range in complexity depending on the needs of the organization, but all are imperative for proving the success of a CDI or coding program.
Susan Belley, M.Ed., RHIA, CPHQ, and Audrey Howard, RHIA, write that a majority of inpatients during this omicron surge are admitted for reasons other than COVID-19 and are incidentally found to be COVID-19-positive—making this an opportune time to review ICD-10-CM reporting for COVID-19 as a secondary diagnosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM, says that when reporting sepsis in ICD-10-CM, it’s important that evidence of sepsis is found throughout the body of a patient’s medical record. A clinical validity query may be necessary if the provider confirms the diagnosis of sepsis, but clinical evidence is lacking in the documentation.
Departmental silos are prevalent in the healthcare world and can lead to unvoiced frustrations and counterproductive work. This article reviews how different organizations have various approaches to breaking down these walls.
Many physicians are not entirely aware of the denials landscape and their involvement in it is often something they never anticipated. Educating physicians on their role in coding denials is important as it will help ensure proper reimbursement. Part two of this two-part series discusses involving physicians in administrative law judge appeals and monitoring success rates.
Anneleah Williams-Bridges, MS, MBCA, RHIA, CCS, CCS-P, CCDS, RH-CBS, LIA, says that until recently, many organizations have solely used their coding and CDI resources to strengthen the capture of CCs/MCCs, severity of illness/risk of mortality scores, and MS-DRG validation; however, facilities that are not leveraging these teams for denials management and tracking denials as a key performance indicator should consider doing so.
