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Healthcare Hotbed for Fraud Cases

While it might surprise some folks that five Modesto doctors are among those facing fraud charges in a $40 million medical billing and kickback case based in Southern California, it shouldn’t surprise anyone that there was yet another medical fraud case. Wherever there is money, you’ll find people or institutions are that ripe for defrauding, […]

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When Practices are Too Cautious about HIPAA

Many providers have the belief that HIPAA should be treated like well-regarded advice from your mom: It’s better to be safe than sorry. But that mentality is not always the way to go. Sometimes, practices can be too cautious with HIPAA. There’s a difference between ensuring protected health information (PHI) doesn’t fall in the wrong […]

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ICD-10 Diagnosis Codes That Identify Weeks Gestation of Pregnancy

ICD-10 Diagnosis Codes that identify weeks gestation of pregnancy and birth weight requirement when billing a delivery CPT Procedure Code Effective for Dates of Service beginning January 1, 2017, and thereafter, Medicaid required a Weeks Gestation of Pregnancy Diagnosis Code and a birth weight on delivery claims billed on an UB-04 or CMS 1500 Claim […]

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OB Coding: Delivering Accurate Coding Remains a Challenge

To quote Robert F. Kennedy, “There are those that look at things the way they are, and ask ‘why?’ I dream of things that never were, and ask ‘why not?’” Coders are experts at scanning provider documentation and assigning codes. My approach to chart review is to try to piece together what actually happened during […]

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CMS Told To Crack Down On Improper Medicaid Payments

The Centers for Medicare & Medicaid Services needs to step up its involvement in states’ Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report. CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. […]

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CMS Updates ICD-10 Quality Measures, More from C&M Meeting

The Centers for Medicare and Medicaid Services (CMS) has released an update to the ICD-10 and Quality Measures website. The home page covers ambulatory surgical centers, hospital inpatient and outpatient, Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) Surgical Site Infections (SSI) Measures, CMS outcome and payment measures, Agency for Healthcare and […]

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14 Things To Know About Medical Coding

Medical coders play a crucial role in the revenue cycle process, as they help ensure health systems, hospitals and physicians are properly reimbursed for the services they provide. Here are 14 things to know about medical coding. 1. AAPC describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal […]

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Outpatient CDI: Is it an Offshoot of Traditional CDI Programs?

There has been a wide array of discussion through published articles, forums, webinars, and meetings about the topic of outpatient clinical documentation improvement (CDI) programs. Outpatient CDI is receiving much attention and experiencing traction in the healthcare industry due to providers coming to terms with the fact that documentation truly matters from a financial perspective, […]

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Clearing Up Confusion Over ICD-10-CM Guidelines

The Health Insurance Portability and Accountability Act (HIPAA) requires covered entities to adhere to the most current International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code set as well as ICD-10-CM guidelines. It is important that the Academy be made aware of payers that do not follow ICD-10-CM guidelines as this is a direct […]

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COPD and Pneumonia: Code First or Code Also?

One subject brought up several weeks ago on an edition of Talk Ten Tuesdays was the sequencing of J44.0, chronic obstructive pulmonary disease (COPD), with acute lower respiratory infection and pneumonia. Guest Stacey Elliot referred to the Coding Clinic from the third quarter of 2016, which says: “based on the instructional note, the COPD must […]

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Key ICD-10 Changes That Impact Pathology/Lab Coding in 2017

Have you updated your reporting of malignant carcinoid tumors, viral hepatitis, GIST or ovarian cyst coding? You haven’t had to deal with annual ICD-10-CM updates until Oct. 1, 2016. Now that the changes are effective, ensure your lab is on top of the latest changes. Take a look at how the first annual update in […]

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What Should Hospital Administrators Concentrate More On?

Hospital administrators have to juggle between various tasks like managing finances, projects and the usual daily hospital operations. To top it all, the priorities are constantly changing from one department to another. Consequently, it is very important to know which task takes precedence over the others. Here are a few points that can help you […]

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Remote CDI: A Remote Possibility?

During a recent edition of Talk Ten Tuesdays, Dr. Erica Remer responded to a listener’s question about clinical documentation integrity specialist (CDIS) working remotely. Here is Dr. Remer’s response. As I tell residents, historically, charting and chart review was done on the floor, because that’s where the chart was. Clinical documentation integrity specialists (CDISs) and […]

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C&M Update: Enhancements to ICD-10 Continue

The ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee met this past week, and there were lots of proposed enhancements to the code set presented and discussed. According to the Oxford dictionary, “enhancement” means an increase or improvement in quality, value, or extent. This definition truly describes the efforts of the C&M Committee and those who participate […]

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ICD-10 Codes Aren’t Oppressive After All

Alexander Miller, M.D., a dermatologist in Yorba Linda, Calif., has a simple message for colleagues grappling with the new ICD-10 codes: Don’t panic! “It’s just a matter of restructuring one’s thinking,” Dr. Miller tells Dermatology Times. “It was no problem for us to handle these codes,” he says, even in his office that continues to […]

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Contact with Nonvenomous Frog, Subsequent Encounter

EDITOR’S NOTE: This article focuses on physician engagement and ICD-10 education. However, the term “physician” includes everyone licensed and credentialed to record a patient diagnosis, such as wound care and other clinical staff. St. Joseph’s Healthcare System (SJHS)in Paterson and Wayne, N.J. is truly an ICD-10 success story. Under a new administration and clinical documentation […]

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