Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant

The goal was to avert fraud, waste, and abuse. We all support that – we collectively pay for Medicare, and who likes throwing their money away? Let’s review the ideal: the patient receives excellent medical care, the provider does a good job documenting that care, the coder translates the documentation into codes that are submitted […]

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Is Cyber-Security Insurance Right for Your Practice?

2015 was a notorious year for cyber attacks in the healthcare industry, with more than 100 million health care records compromised in a single year. So far 2016 looks like it might be as bad or worse, once the Department of Health and Human Services’ (HHS) Office of Civil Rights (OCR) gets all the breaches […]

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Downgrading DRGs: A New York Epidemic Out of Control

Do you find that your facility’s DRGs are being downgraded by third-party payers that are re-diagnosing patients? Are they also discounting the coding of suspected and possible diagnoses? You’re probably not alone. Sonya Manuel, a senior health information management (HIM) consultant and DRG coordinator for Jzanus Consulting in New York, tells RACmonitor that the battle […]

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Guideline Changes: Taking a Step Backward?

The recent buzz surrounding changes to the ICD-10-CM guidelines have many wondering why we appear to be taking a step backward from quality instead of elevating standards with language indicating that physicians don’t need to document to meet clinical indicators or support conditions with their documentation. Keep in mind that there is never one set […]

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The End of Relaxed ICD-10 Rules: What it Means for Private Practices

Physician practices have had nearly a year to acclimate themselves to the ICD-10 coding that took effect in October 2015. Thanks to a grace period known as ICD-10 “relaxed rules,” which were established jointly by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA), the use of ICD-10 codes that […]

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CMS ICD-10 Coding Grace Period Comes to a Halt October 1, 2016

Since the update from ICD-9 to ICD-10, has your business successfully made the transition to the new coding system, or are you still struggling to keep up? If it’s the latter, very little time remains! According to CMS, October 1, 2016, will be the cutoff date for the use of unspecified or less specific codes […]

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Ten Things About Oct. 1 That You Need To Know Now!

The 2017 Inpatient Prospective Payment System (IPPS) final rule brings with it a number of changes that are likely to have an even bigger impact on documentation, coding, and revenue than ICD-10 itself. An unprecedented number of dramatic changes will go into effect on Oct. 1. I knew that things were going to be interesting […]

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4 Medical Billing Issues Affecting Healthcare Revenue Cycle

Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle. Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform. Top four medical billing challenges impacting healthcare revenue cycle. The […]

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ICD-10 Pre-Bill Auditing a Growing Area of Concern

Given the massive number of new ICD-10 codes and the Oct. 1, 2016 compliance date, HRS and ICD10monitor are producing a special-edition Internet broadcast that will focus on the imperative of pre-bill auditing. The free broadcast will air live at 1:00 p.m. on Thursday, Aug. 4. The 60-minute live event is being sponsored by HRS. […]

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Office of Inspector General Gives Green Light to Hospice Provider’s Payment to Nursing Facilities

Last week, the Office of Inspector General, OIG, issued a favorable opinion to a hospice provider seeking to make supplemental payments to skilled nursing facilities. Under the proposed arrangement, the hospice provider would make a supplemental payment to the nursing facility for dual-eligible individuals electing the hospice benefit that would be in addition to and […]

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Understanding How EHR Use, Adoption Impacts Physicians

Many researchers have investigated the impact EHR use and EHR adoption has on physicians and hospitals, showing that the technology still has both pros and cons. Since the 2009 passage of the HITECH Act and the start of meaningful use, EHR adoption has become widespread throughout the healthcare industry. Despite the near ubiquity of EHR […]

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The Influence of a Specific Ophthalmological Electronic Health Record on ICD-10 Coding

Abstract Background A specific Electronic Health Record (EHR) for ophthalmology was introduced in an academic center in Germany. As diagnoses coding corresponding to the International Classification of Diseases Version 10 (ICD-10) is mandatory for billing reasons in Germany, we analyzed whether a change occurred in the diversity and number of diagnoses after the EHR introduction. […]

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World Health Organization Says Transgender is a Mental Illness

According to the World Health Organization, being transgender is a mental illness. But that could soon change, as the WHO prepares a new edition of the International Classification of Diseases (ICD), its global codebook that influences disease diagnostic manuals worldwide. The current version, ICD-10, was endorsed in 1990, and ICD-11 is due in 2018. The […]

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Reducing Your Risk and Staying the Course

One thing always remains the same in healthcare: change. With the implementation of ICD-10 we found out how disruptive some of these changes can actually be, and it appears that this was only a precursor to even more change in healthcare, with the implementation of new quality payment initiatives. During the ICD-10 implementation, we began […]

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Good News, Bad News: The Saga Continues

The long-awaited update to the CT lung screening national coverage determination (NCD) was finally released this month. As you may recall, current smokers who were otherwise eligible were omitted from the NCD-covered codes released last year. That is the really good news. The really bad news is that at least one Medicare Administrative Contractor (MAC) […]

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CMS Targets Heart Disease With New Program

More than 500 healthcare practices have been selected to participate in a new pilot program designed to prevent heart attacks and strokes in Medicare patients, the Centers for Medicare & Medicaid Services announced Thursday. The Million Hearts Cardiovascular Disease Risk Reduction Model is the latest idea from the CMS Innovation Center, which conceptualizes and tests […]

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