Coding Diabetes: Time to Look at the Coding Guidelines Again

During November, the Centers for Medicare & Medicaid Services (CMS) is raising awareness about diabetes, diabetic eye disease, the importance of early disease detection, and related preventive health services covered by Medicare. According to the CMS website, diabetes can lead to severe complications such as heart disease, stroke, vision loss, kidney disease, nerve damage, and […]

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Hospitals, Systems Spend $39B Annually on Regulatory Compliance

Hospitals, health systems, and post-acute care providers spend almost $39 billion annually on administrative tasks related to regulatory compliance, the American Hospital Association (AHA) reported. “As a result of this extraordinary burden, providers are struggling to balance the administrative activities necessary to comply with regulatory requirements against the clinical, operational and financial activities necessary to […]

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The Hidden Tragedy of the Opioid Crisis

When President Trump declared the opioid crisis a public health emergency Thursday, he noted that “last year we lost at least 64,000 Americans to overdoses.” He is not incorrect. A preliminary analysis for 2016 from the Centers for Disease Control and Prevention estimated the toll at 64,070, up from 52,898 in 2015. What rarely gets […]

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Nursing Shortage Hits Crisis Levels

A shortage of experienced nurses has hit the United States, particularly in rural communities, forcing many hospitals in the Midwest to recruit nurses from one another. One way hospitals have tried to alleviate the crisis is by using foreign nurses to fill the gap. But it can take years for nurses to obtain a visa […]

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CMS Publishes RADV Medical Reviewer Guidance

In the Medicare Advantage (MA) context, “risk adjustment” is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage Organizations (MAOs) based on demographic factors and the health status of enrolled members. By regulation, MAOs must submit risk adjustment data that characterize the content and purpose of items and services […]

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Emergency Care: CDI in the ED Part II

EDITOR’S NOTE: This is the final installment in a two-part series on clinical documentation integrity (CDI) in the emergency department (ED). It is my opinion that investing CDI resources into the neglected stepchild that is the hospital system ED is a worthwhile endeavor. Getting diagnoses captured early and repeatedly creates performance improvement. Even more importantly, […]

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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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