Importance of DRG Reconciliation in the CDI and Coding Processes

The Centers for Medicare & Medicaid Services (CMS) performs diagnosis-related group (DRG) validation to ensure that reported diagnostic, procedural, and discharge status information matches both the attending’s description and the information contained within the beneficiary’s health record. CMS auditors are instructed to validate the principal diagnosis, secondary diagnoses, and procedures affecting or potentially affecting the […]

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MIPS Reporting: MACRA Final Rule Lists Available Quality Measures for MIPS reporting

MIPS Eligible Clinicians can opt to report as individuals or as a group. A group is defined by the Tax Identification Number (TIN). If you choose this option, the group will be assessed as a group practice across all four MIPS performance categories. Eligible clinicians can take their reporting scores with them if they should […]

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Reimbursement, Billing in Radiology: Updates and Issues

Radiology, as a business, has become increasingly complex as regulatory demands grow and revenues, both on the hospital and physician side decrease. Doing more with less has become a common theme and both the commoditization of billing as well as the implementation of ICD-10 codes have played an important role over the past year, according […]

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The Evolution of the International Classification of Disease

The International Classification of Disease is perhaps one of the most important diagnostics documents in the medical world. It categorizes diseases and medical incidents that can be encountered, and the document reflects a broader context in which it is created. The ICD aids with health policy decision making and can with a process of finding […]

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Coding for Clarity: Echocardiography Gains Two New CPT Add-On Codes

New technologies need new codes CPT codes describe medical, surgical and diagnostic services and procedures. These codes communicate uniform information about medical services and procedures to healthcare providers, payers, administrators and accrediting bodies. They are also vital as financial and analytical tools. New codes are necessary when novel technologies enter clinical practice, as was the […]

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Healthcare Reform Can Create Confusion Over Compliance for Providers

In 2016, the federal government recovered more than $3.3 billion in healthcare fraud judgments and settlements. On Monday, TeamHealth agreed to pay $60 million to settle allegations that a company it acquired, IPC Healthcare “knowingly and systematically encouraged false billings by its hospitalists.” The settlement is the latest in a string of False Claims Act […]

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You Had Better Be Savvy With Your Coding

With the change in payment focusing on quality medicine instead of the old-fashioned fee for service, providers better be savvy with their coding or they will lose out on the money needed to run their practices. As individual and groups of physicians align with other groups to provide excellence in care while cutting costs, it […]

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Navigating ICD-10: Tips For Hospitals and Coders

More than one year after the ICD-10 go-live on Oct. 1, 2015, CMS has ended the ICD-10 claims auditing and quality reporting leniency period. Guidelines now require providers to code to reflect clinical documentation in as much specificity as possible. Therefore, hospital and health system leaders must ensure both new and experienced coders are prepared […]

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Everything Doctors Should Know About ICD-10 Glitch

CMS has announced a glitch in the quality reporting measures brought upon by the changes in the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) updates that went into affect Oct. 1. While CMS is a bit unclear as to exactly what the problem is, there are a few things we know: This glitch only […]

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How to Successfully Communicate Your Clinical Validation Concerns

Five tactics to educate physicians and improve documentation. Q: Our coders and coding auditors often see patterns of incorrect physician documentation. Sometimes the error impacts the MS-DRG, but many times it does not. What recourse do we have to communicate our clinical validation concerns? A: Your situation is certainly not unique. In a world where […]

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ICD-10 Glitch Causes CMS To Relax Payment Penalties

Massive ICD-10 code update is responsible for clogging system and leading to reporting problems. ICD-10 has hit yet another snag after massive code updates resulted in a clogged system and reporting problems for the Physical Quality Reporting system. As a result, CMS has decided to waive the penalties for 2017 and 2018. All eligible professionals […]

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Top 5 Tips for Combating 2017 Coding Concerns

The calendar may say the ICD-10 transition is long gone, but practices still will likely feel its repercussions in 2017 in terms of payer requests, denials and the new code set’s influence on value-based care. Looking to next year, practices should start being proactive with these coding opportunities now to consider how the following five […]

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Surprise Medical Bills: Why They Occur And What To Do

Imagine going on Amazon, buying an Electronic Spin the Bottle Game for its listed price of $32.92, receiving the product (sparing the arduous effort required to spin the bottle) and then several weeks later receiving an additional bill for $600. As indicated in a recent study, that’s basically what’s happening in heathcare…quite frequently. Not spin-the-bottle, […]

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11 Ways To Save Money on Medical Expenses

My health insurance plan jumped 24 percent this fall and dropped in quality of coverage. I’m not alone. Rising health insurance costs across the nation have many people worried. A recent 50-state poll released by the Partnership to Fight Chronic Disease revealed that 77 percent of consumers have experienced difficulty using their health insurance in […]

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ICD and DSM Coding Compliance Will Be Important In 2020 and Beyond

On October 1, the grace period for allowing providers to submit “less-than specific” codes ran out. If you recall, when ICD-10-CM went live in 2015, the federal government gave providers a transitional year to adjust to the shiny new code set, get educated and hone their skills at making specific diagnoses. All is well, right? […]

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What’s the Key to Better ICD-10 Coding?

Nearly a quarter of all U.S. hospitals now outsource some or all coding functions. Ninety percent of hospitals over 150 beds currently outsourcing their CDI processes reported in Q3 to have realized significant (over $1.5M minimally) in appropriate revenue and proper reimbursements following the implementation of clinical documentation improvement programs in this past year following […]

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