It is estimated that 80 percent of Americans report back pain at one time or another, and treatment for such issues comes at a cost of $50 billion annually. Roughly 40 percent of those with back pain seek help from a primary care physician; another 40 percent see a chiropractor,…

EDITOR’S NOTE: 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…

It’s so important that we in the healthcare industry continue our discussion regarding the topic of Hierarchical Condition Categories (HCCs), as the risk-adjusted payment models are increasing in prevalence.The assignment of HCCs and risk adjustment has extended beyond Medicare Advantage plans as a result of the Patient Protection and Affordable…

While most legacy clinical documentation improvement (CDI) programs have been doing a good job at preserving revenue under the MS-DRG system, a potential blind spot exists. Value-based and alternative payment models (APMs) rely on the concept of risk adjustment to determine final payment in acute care. The Centers for Medicare &…

While most legacy CDI programs have been doing a good job at preserving revenue under the MS-DRG system, a potential blind spot exists as Value-Based and Alternative Payment Models rely on the concept of Risk Adjustment to determine final payment in acute care. The Centers for Medicare & Medicaid Services risk…

This is the second installment in my series of articles addressing clinical validation denials. Clinical validation denials (CVDs) are the derivatives of diagnosis-related group (DRG) coding validation denials. The latter is a rejection of a claim on the basis of reviewing physician documentation and determining that the correct codes or…

All healthcare providers must now be (ICD-10) coding to the highest level of specificity. The ICD-10 flexibilities available during the first year of implementation are gone for physician billing.As of Oct. 1, 2016, all providers are required to code to accurately reflect the clinical documentation in as much specificity as…

ICD10monitor’s resident psychiatrist, H. Steven Moffic, MD, who is also a popular guest on Talk Ten Tuesdays, recently received the received the Administrative Psychiatry Award from the American Psychiatric Association (APA) and the American Association of Psychiatrist Administrators (AAPA). The award was presented to Moffic on Oct. 6, during the fall…

In my previous article, Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant, I suggested that one of the actions to prevent unjustified clinical validation denials (CVDs) is to perform concurrent clinical documentation integrity (CDI) reviews and pre-bill audits. Permit me to expound on the role of CDI reviews in…

For coders and clinical documentation improvement (CDI) specialists, the nuances and changes regarding coding superbug infections remain as dynamic as the pathogens themselves. Medication resistance, and especially antibiotic resistance, can be a challenging issue in the coding world.The bacteria in question include enterococcus, staphylococcus, klebsiella, acinetobacter, pseudomonas, and enterobacter. In…