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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3 Ways to Reduce the Aged Trial Balance Report

Healthcare providers need to get paid to survive. This might be the most basic business 101 principle, so why do many companies – particularly health providers – still struggle to reduce outstanding invoices? “Accounts receivable aging lists unused credit and unpaid invoices by date.” Unfortunately many patients don’t (or can’t) pay their health bills on […]

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Elimination of LCDs Proposed

This is the year of many Centers for Medicare & Medicaid Services (CMS) regulatory requirement changes. This includes the Merit-Based Incentive Program (MIPS), the next steps toward mandatory Authorized Use Criteria (AUC) implementation for advanced imaging, defining more explicitly what is and what is not “quality” care, etc. It is important to understand that all […]

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CMS Cancels Two Mandatory Pay Models and Scales Back a Third

The CMS on Tuesday said it will toss two bundled-payment models and cut down the number of providers required to participate in a third, citing providers’ requests to have more input in the models’ designs. The agency slashed the number of mandatory geographic areas participating in the Comprehensive Care for Joint Replacement, or CJR, model […]

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Learning ICD-10: Documenting Type 2 Myocardial Infarction

I am in the middle of a heads-down project, but I popped my head up long enough to read the new ICD-10-CM guidelines for 2018 (thanks for the notification, Gloryanne Bryant!). I had to take a moment to comment on the Type 2 myocardial infarction (MI) guidelines. The reasons we should be documenting and coding […]

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Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

Overview On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2018 final policies are summarized below. Updates to […]

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Does a CDI Program Improve Physician Engagement?

Last month, the American Health Information Management Association (AHIMA) released a practice brief titled “Impact of Physician Engagement on Clinical Documentation Improvement Programs.” The brief contains some extremely valid and interesting points. Genuine, consistent physician engagement is essential for any clinical documentation improvement program meant to achieve scale and long-term sustainability. The practice brief starts […]

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Moving Your Practice Past Industry Benchmarks

I often get the question, “What should my monthly numbers be?” My first response is, taking into account collections among other things affecting their practice, “What are your minimum requirements, annual goals, and what amount of time and energy are you willing to put in, in order to reach those results?” This is not the […]

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Release of New Codes Coming Down to Wire

Why is it important to take these new code changes seriously? It is extremely important to for coders, but we have to think of opportunities for documentation improvement and physician documentation. For simplicity, we want to minimize errors and maximize output. For many of this year’s code changes, we already see the documentation in record, […]

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Doctors Would Report Opioid Diagnosis Codes Under Deal

Ohio doctors would report the specific diagnosis of every patient who receives a prescription painkiller under a tentative agreement reached Friday with the Kasich administration. The 11th-hour compromise between the Republican governor’s office, the state Medical Board and associations representing doctors and hospitals followed months of wrangling over new opioid prescribing rules proposed in April […]

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