Health information management, Hospital outpatient, Training
Coders should make sure their physicians and qualified healthcare professionals (QHP) are ready for the crucial role in reporting HCPCS Level II code G0136 (administration of a standardized, evidence-based social determinants of health [SDOH] risk assessment tool, 5-15 minutes, not more often than every 6 months).
While practices can perform a SDOH assessment for all of its patients, members of the medical team will take the lead in identifying patients who meet Medicare’s requirements for the billable service.
Share the following illustration with providers to help them negotiate Medicare’s rules. This tool was originally published on Part B News.
Coders had to review and update their training materials for split/shared visits for physician reporting when CMS completely revamped the rules in 2022. It wouldn’t hurt to do so again with this tool to make sure they match the CMS rules and CPT manual guidelines that went into effect January 1, 2024.
Auditing and monitoring, Hospital outpatient, Training
This resource deconstructs the components of the revenue cycle and explains how coding affects denials and reimbursement. This resource was created by Laurie Bouzarelos, MHA, CPC, of Provider Solutions.
Auditing and monitoring, Hospital outpatient, Physician practice
CMS and other federal agencies opened up telehealth coverage policies during the COVID-19 public health emergency (PHE). Even though the PHE came to an end May 11, 2023, virtual care options (otherwise known as "teleheath" services) remain popular. From coverage rules and compliance tips, this guide will help coders and providers navigate the world of remote patient monitoring services.
Auditing and monitoring, Clinical documentation, Health information management, Hospital inpatient, Hospital outpatient, Physician queries
Guidelines for Achieving a Compliant Query Practice was produced through the joint effort of the ACDIS and AHIMA. Both associations collaborated on the creation of this practice brief and approved its contents, and as such it represents the recommended industry standard for provider queries.
This practice brief supersedes one published in 2019 and all previous versions. This resource was originally published on ACDIS.org.
The following physician reporting scenario portrays a patient encounter that would lead to a visit that would be reported with CPT code 99214 (office or other outpatient visit for the E/M of an established patient, which requires a medically appropriate history and/or examination and moderate level of MDM. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter) under the current E/M office visit guidelines.
This sample was provided by Laurie Baker, MSN, RN, CCDS, clinical documentation specialist at Memorial Hospital and Health Care Center in Jasper, Indiana. It was originally posted on ACDIS.org.
This sample was reviewed and approved by the ACDIS Resource Library Committee in 2023. The committee recommends that, should you choose to use this sample, you adapt it to your particular programmatic needs, policies, and procedures. Additionally, the committee notes that the ACDIS Pocket Guide is used as a reference in this sample and should be cited as such. Individuals adapting this sample should also customize the list depending on individual facility data and provide links to the full 4th Universal Definition of MI and the KDIGO guidelines.
This sample was provided by Laurie Baker, MSN, RN, CCDS, clinical documentation specialist at Memorial Hospital and Health Care Center in Jasper, Indiana. It was originally posted on ACDIS.org.
This sample was reviewed and approved by the ACDIS Resource Library Committee in 2023. The committee recommends that, should you choose to use this sample, you adapt it to your particular programmatic needs, policies, and procedures. Additionally, the committee suggests adding options for morbid obesity, cachexia/underweight (BMI <19.9), hepatic failure, viral pneumonia, and acute on chronic respiratory failure. Those looking to shore up their documentation for denial prevention may also want to add a section about treatment plans.
This sample was provided by Laurie Baker, MSN, RN, CCDS, clinical documentation specialist at Memorial Hospital and Health Care Center in Jasper, Indiana. It was originally posted on ACDIS.org.
This sample was reviewed and approved by the ACDIS Resource Library Committee in 2023. The committee recommends that, should you choose to use this sample, you adapt it to your particular programmatic needs, policies, and procedures.
