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New Diagnostic Codes for Substance Use Disorders and Avoidant/Restrictive Food Intake Disorder

Once a year, the National Center for Health Statistics (NCHS), the federal agency responsible for the use of the International Classification of Diseases – 10th revision (ICD-10) in the US, releases an updated version of the ICD-10-CM, the HIPAA-adopted code set for medical diagnoses used by medical providers, insurers, and health care administrators. The 2018 […]

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New Coding Study Reveals E&M Encounters Per Hour and the Need for Cyber Security

In a recent poll, only 80 percent of respondents to a question of how many evaluation and management (E&M) encounters they could code per hour said that they spent at least some portion of their time at work performing that task. I am not certain as to the reason for this; however, I do plan […]

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Providers Take Note: These Simple Strategies Will Improve Billing, Patient Satisfaction

Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture. A new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out on key areas to improve when it comes to patient billing, payments and satisfaction. The Digital Payments Progress report, a product of a partnership with […]

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From Bundled Payment Reform to MACRA: Pick Your Poison

MACRA continues to be a subject that perplexes providers even as the program evolves. It has been recently confirmed that the Comprehensive Care for Joint Replacement (CJR) bundled payment has been cut from 67 to 34 percent in the program, and the carding rehabilitation incentive with bundled payments has been cancelled. The new political leadership […]

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Faster Preoperative Heart Rate Linked to More Postoperative Myocardial Injury

Postoperative myocardial injury is correlated with increasing resting preoperative heart rate in noncardiac surgery patients, according to a new study. Interestingly, the researchers concluded that the relationship may be J-shaped instead of linear, demonstrating that abnormally low heart rates may be potentially dangerous, too. “One of the theories about myocardial injury is that heart rate, […]

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Physician Practices Examine Risk Adjustment Coding in Wake of Federal Lawsuits

A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn’t involve physician practices, many practices are now paying more attention to risk adjustment coding than ever. At the heart of the UnitedHealth lawsuit is the claim that […]

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Looking at new ICD-10-CM Codes for Blindness

ICD-10 codes for blindness and low vision are effective Oct. 1, 2017 and reflect parameters from the World Health Organization (WHO). A new set of codes was released for use beginning on Oct. 1, 2017. The category, H54, includes codes for blindness and low vision and with that brings many changes for documentation and coding. […]

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OIG: Acute Care Hospitals Owe Medicare $51.6M, CMS Agrees to Provider Clawbacks

A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the money back. The Centers for Medicare and Medicaid Services has agreed to claw back the $51.6 million and require hospitals to refund patient copays and […]

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You Should Worry about Medical Coding Guidelines Changing

Changes are coming with Evaluation and Management (E&M) coding guidelines. I will use this space to explain why these changes will be both a good thing and a challenge to physicians, particularly those who derive much of their income from office visits. CHANGE IS OVERDUE It has been 20 years since the 1997 E&M guidelines […]

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What Was Missing at the ICD-10 C&M Meeting?

Much was covered during the ICD-10 Coordination and Maintenance Committee (C&M) meeting last week at the Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore. The first striking item was that there were no procedure proposals made during this meeting. There was discussion about three root operations – creation, control, and extraction. The definition […]

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Turning Around a Troubled Revenue Cycle

Accurate, efficient revenue cycle management is essential to maintaining positive cash flow in a healthcare facility. Maintaining positive health care finances requires that claims processing and payments are effectively managed and that claims are “trackable at all points so issues can be addressed in a timely manner. First, hospitals must learn what their issues are […]

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CMS Proposes 1.9% Increase in 2018 ASC Pay, Adding Total Joint Replacements

CMS released a proposed rule that would update the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. Here’s what you should know about the ASC-related changes: 1. CMS is proposing to increase payment rates by 1.9 percent to ASCs that are meeting quality reporting requirements. CMS based the increase on the […]

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ICD-10 New Codes: Pressure Mounts as Deadline Approaches When New Codes Become Effective

Now it’s just a little less than three weeks until the beginning of October and when the fiscal year (FY) 2018 changes for ICD-10-CM take effect. Here is a summary of the new changes for ICD-10-CM: 360 new code additions 142 deletions 250+ revisions The Centers for Medicare and Medicaid Services (CMS) published a variety […]

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ICD-10 QUICK TIPS: Back to School Bugs Part I

It’s the most wonderful time of the year! That’s right, it’s back to school for the kiddos. As the hustle and bustle of the new school year starts and the morning drive (flashing red, school bus ahead) slows to the pace of a horse and carriage ride, our children will soon be sharing more than […]

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ICD-10 Gets Down to Specifics, and Attention to Detail Directly Affects Finances

This year, getting reimbursed is all about making sure the codes reflects the actual care given. For ICD-10 changes this year, the devil’s in the details. When ICD-10 was first implemented on Oct. 1, 2015, it was a nail-biting flip of the switch and then a sigh of relief when denials didn’t mount up as […]

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Conditions That Risk-Adjust for Inpatients Not Always the Same for Outpatients

Last week Tracy Boldt contacted me to ask a question about outpatient clinical documentation integrity (CDI), and we are lucky to have her on the Talk-Ten-Tuesdays broadcast today, detailing Essentia Health’s successful outpatient CDI program. She also mentioned that she had been awaiting the third installment of my three-part series on outpatient CDI. I was […]

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