The underlying etiology is sequenced first and the manifestation, or the presentation of the disease process, is coded second. Recently I was listening to a podcast called Coder vs. CDI…
Refinements continue for the evaluation and management (E/M) office-visit and outpatient documentation and coding reforms that took effect this year, and these include technical corrections updates to the Current Procedural…
The present world which we are working at right now is completely filled with far more opportunities to turn up everything right for ourselves. When we are progressing just in…
On April 27, 2021, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS). The…
Since the World Health Organization (WHO) announced the release of the International Classification of Diseases, Eleventh Edition (ICD-11) in 2019, the opinion among industry insiders regarding U.S. adoption of the…
CMS has raised the Medicare payment rate for certain COVID-19 antibody infusions and included a new payment policy for at-home administration, which will have a higher payment rate compared to…
Medical necessity guidelines must also be carefully reviewed for their applicability to the individual patient. The term “medical necessity” is used far and wide in medical care. But medical necessity…
Many nursing home COVID-19 patients would have benefited from daily, reimbursed-for physician visits in their skilled nursing facilities, but they were not entitled to them. With an epic crisis still…
Proposed rules offer insight into the Administration’s priorities. The Centers for Medicare & Medicaid Services (CMS) has issued its first proposed payment rules under the Biden Administration. While these rules…
With dwindling provider availability and a growing patient population, the healthcare industry is increasingly turning to technological advancements to improve patient outcomes. During the pandemic, the industry was forced to…
By April of last year, seemingly every news station in American was featuring the heroic efforts of physicians, nurses, and other clinicians fighting COVID-19. These providers transformed healthcare, implementing telehealth…
Providers should be aware of these emerging strategies for defending against audits. For years, providers have been plagued with defending claims for medically necessary services that have been denied due…
There are certain key elements of consideration during CDI review of COVID-19 patients. Understanding how to clinically validate sepsis and differentiate between sepsis and septicemia is not easy, and requires…
Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new…
Inpatient hospital stays have become more expensive to the Medicare program. It's a trend that began even before the COVID-19 pandemic. A new report from the Department of Health and…
The Medicare IPO list was doomed years ago. For readers of and listeners to RACmonitor and Monitor Mondays, overthinking things is what we do. It’s the only explanation for our…