Some New Myocardial Infarction Codes Challenge Interpretation

The addendum for new codes coming out was recently released with many notable additions and deletions. The next several articles in this series will address some of these conditions in order to help us get ready for the October 1 implementation date. One of the things I love most about getting the codes well before […]

Continue Reading Comments { 0 }

DOJ Charges Hundreds With Opioid-Related Fraud

The U.S. Department of Justice (DOJ) arrested 412 individuals, including 115 licensed medical professionals, across the country for alleged involvement in health care fraud schemes totaling around $1.3 billion in false billing and “unlawful” distribution of opioids and other narcotics, according to a statement. It is the largest health care fraud enforcement action ever taken […]

Continue Reading Comments { 0 }

Final ICD-10-CM Codes for 2018 Contain a Few Surprises

The final codes include 322 more changes than what was proposed by CMS in April’s hospital IPPS rule. Starting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine. Those nine new […]

Continue Reading Comments { 0 }

How to Avoid TCM Coding Denials

• CPT code 99495 (TCM with moderate medical decision complexity and a face-to-face visit within 14 days of discharge) • CPT code 99496 (TCM with high medical decision complexity and a face-to-face visit within 7 days of discharge) Payment information: CMS began paying for TCM in 2013, and many commercial payers began doing so shortly […]

Continue Reading Comments { 0 }

Clinical Documentation Integrity: Where Business Acumen Governs High Performance

Clinical documentation integrity (CDI) as a profession is quite similar in nature to running a business. Successful businesses exhibit certain operational qualities and traits that serve to ensure continued growth and prosperity, and their leaders possess a long-term vision and ability to consistently meet, exceed, and solidly predict current and future needs of their customers. […]

Continue Reading Comments { 0 }

ICD-10: Abide By These Rules When Coding Foreign Bodies

Know when to apply these secondary codes. Foreign bodies (FBs) entering through one of the three ENT-specific pathways is a relatively common occurrence. While these situations are found primarily with children presenting for service, FBs of the ear, nose, and throat don’t necessarily discriminate when it comes to age. However, when it comes to coding, […]

Continue Reading Comments { 0 }

Price Gouging in the ER: Patients Often Overcharged

Emergency departments across the United States charge adult patients 340% more than what Medicare pays for services, but minorities and the uninsured receive the biggest bills, according to new research from the Johns Hopkins University School of Medicine. The study, published in JAMA Internal Medicine, found that on average emergency departments charge anywhere from 1.0-12.6 […]

Continue Reading Comments { 0 }

Patient Safety Jeopardized by EHR Downtime, JAMIA Says

Downtime events in hospitals that shut down the functionality of the electronic health record can result in serious patient safety risks, according to a recently published study in the Journal of the American Medical Informatics Association. In fact, over the three-year analyzation period of a large health system in the Mid-Atlantic, 76 incidents were reported […]

Continue Reading Comments { 0 }

Optimizing the Monitoring of ICD-10 Coding Productivity

With the help of hindsight and data, we can now more accurately predict coding productivity and staffing needs. The run-up to ICD-10 had most of us very concerned, expecting to experience a decline in productivity of as much as 40 percent or more. Early productivity reports, based on perceptions and/or small sample sizes, confirmed that […]

Continue Reading Comments { 0 }

Final ICD-10-CM Codes for 2018 Contain Some Surprises

Revisions include 322 more changes than CMS proposed in April The final updated ICD-10-CM codes for 2018, posted on the Centers for Medicare and Medicaid Services’ (CMS) website, contain 360 new, 142 deleted, and 226 revised diagnosis codes, according to a report from HealthLeaders Media. The revisions include 322 more changes than what was proposed […]

Continue Reading Comments { 0 }

Combining Data Analytics with Expertise to Optimize Claims Performance Management

There’s a smart trend we’re starting to see that starts with a simple equation: E + D = O Where E=expertise, D=data, and O=optimization. Carriers are starting to discover that without professional expertise to turn disparate data into actionable optimization and measurable intelligence, data is powerless. With property and casualty being a dynamic and constantly […]

Continue Reading Comments { 0 }

Outpatient CDI: Is “Outpatient” Out? Part I

There is a great push within the healthcare industry to move clinical documentation integrity (CDI) into the outpatient arena. People refer to this as “outpatient CDI,” but I think this is a misnomer. If you plan on stationing CDI specialists (CDISs) in physician offices, that could be construed as “outpatient CDI,” but I believe the […]

Continue Reading Comments { 0 }

Medicare Compliance: The Basics for Injury Settlement Recipients

Medicare is a government-provided health insurance program designed to assist certain people with hospital care, medical costs, and other expenses. Qualifying beneficiaries are people who are 65 or older, those younger than age 65 with certain disabilities, and people of all ages with permanent kidney failure. How to keep medicare eligibility If you were injured […]

Continue Reading Comments { 0 }

Succeeding in an ICD-10 World: A Peek Inside the New Issue of the AHIMA Journal

In the ICD-9 era, there were universally accepted benchmarks to measure coding professionals’ productivity. Now, more than 18 months after the ICD-10 implementation date, the challenge is to do the same for the new coding system. The article, “Coding Checkup,” in the June issue of the Journal of AHIMA, addresses this issue and provides direct […]

Continue Reading Comments { 0 }

OIG Investigates Payments for Ambulance Transports of SNF Patients

Medicare’s Office of Inspector General (OIG) has issued a sixteen-question survey to many ambulance service suppliers. The survey is focused on SNF patients, and specifically why the ambulance service has billed Medicare Part B for transports while patients were in a Part A stay. During Part A stays, the nursing home receives Medicare payments that […]

Continue Reading Comments { 0 }

Understanding the Basics of Bundled Payments in Healthcare

How do bundled payments fit into the growing value-based reimbursement ecosystem? The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models like bundled payments are helping to define the future of revenue […]

Related Posts Plugin for WordPress, Blogger...
Continue Reading Comments { 0 }