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…

The 2017 Inpatient Prospective Payment System (IPPS) guidelines contain several fundamental changes, and certainly some challenges insofar as clinical documentation improvement (CDI) and coding practices are concerned.As an advocate for integration of coding guidelines into our CDI practice, the 2017 IPPS certainly offers an opportunity for tighter collaboration between the…

If you would allow me to vent a little today, then please indulge me. If you are not in the particular mood for what some might call a rant, well, you should read anyway, because this promises to be an entertaining and thought-provoking example.    The topic is a common criticism…

The 2017 Inpatient Prospective Payment System (IPPS) final rule brings with it a number of changes that are likely to have an even bigger impact on documentation, coding, and revenue than ICD-10 itself. An unprecedented number of dramatic changes will go into effect on Oct. 1.I knew that things were…

One item that has not yet received much attention is a guideline addressing the ability of a facility to report or not to report a diagnosis provided by a physician.What is a facility to do when a physician documents a diagnosis that may be unsupported by the clinical circumstances reflected…