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, Hospital inpatient
This sample was provided by Trey La Charité, MD, FACP, SFHM, CCS, CCDS, a hospitalist at the University of Tennessee Medical Center at Knoxville, a clinical assistant professor with the department of internal medicine, and the medical director of UTMC’s CDI, coding, and revenue auditor response programs.
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 recommends that those adapting this sample make sure to use up-to-date resources and references when formulating their appeals.
Editor’s note: 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.
Auditing and monitoring, Clinical documentation, Hospital inpatient
While everyone involved in health services has an interest in providing quality care, many quality management initiatives are based on regulatory requirements from CMS. As these programs originate from federal initiatives, the ACDIS Regulatory Committee has designed a road map, a quality map, to assist programs with their quality efforts. The quality map provides specialists with tips, techniques, and up-to-date resources to augment your quality programs. We encourage your input and feedback on this quality map.
Note that the quality map was initially published in May 2021 and was most recently updated in July 2023. This resource was originally published on ACDIS.com.
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.
