Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
ICD-10-CM/PCS coding for severe and potentially fatal heart conditions such as aortic valve stenosis (AVS), heart failure (HF), and atrial fibrillation (AF) requires an in-depth understanding of anatomical terminology and clinical indications. Coders need to be able to select the most specific codes based on reported symptoms and the severity of the disease.
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary or excessive services, contributing to rising healthcare costs and the possibility of depleting Medicare funds.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern due to its sustained person-to-person spread within countries and across continental borders.
To enhance efforts to combat the opioid crisis in America, CMS policy allows for a new benefit under Medicare Part B concerning Opioid Treatment Programs.
As with any new clinical documentation integrity (CDI) initiative, there are many possible starting points for outpatient CDI. Review advice from healthcare professionals at Trinity Health on how to successfully implement an outpatient CDI program.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes about conflicting documentation and how coders and clinical documentation integrity specialists can resolve inconsistencies in provider documentation to prevent claim denials.
The fiscal year 2020 inpatient prospective payment system (IPPS) proposed rule threw gas on the population health fire when it proposed giving social determinants of health (SDOH) codes more weight as complications/comorbid conditions (CC).
Prevention of the flu is important as this illness can lead to hospitalization and even death. The CDC reports the hospitalization rate due to the flu is 2.7 per every 100,000 persons, and there is a 4.8% mortality rate due to influenza and pneumonia.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve.
Coding productivity held steady, but missing documentation and unanswered queries bog down coders, according to the results of our 2019 coding productivity survey
HCPro’s 2019 coding productivity survey showed that coding productivity held steady for 2019, but facilities continue to struggle with miscommunications between coding and CDI staff and unanswered physician queries.
If you aren’t yet confused by the site-neutral payment policy changes prompted by CMS apparently ignoring both Congressional intent and the American Hospital Association (AHA) and other impacted hospitals filing suit, you are likely to become so now.
One of the most vexing challenges that CDI specialists have is how to engage physicians to completely and precisely document their patients’ conditions and treatments in the language required by ICD-10-CM, which is essential to risk adjustment.
HIM directors’ and managers’ salaries made gains in some areas, but others may be falling behind, according to respondents of HCPro’s 2019 HIM director and manager salary survey.
As the cost of healthcare continues to skyrocket, payers are looking for ways to save and want to make sure that claims reflect correct information and that the care provided was clinically justified.
Due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy.
