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The sequester is expected to end next year in the absence of any legislation. Times change –  there was a time when deficit spending caps were the talk of Washington, D.C. In 2011, then-President Obama signed the Budget Control Act of 2011 (BCA) as part of an agreement with Congress…
The patient story is paramount to validating a diagnosis of sepsis. MS-DRGs 872 and 871, Septicemia or Severe Sepsis with MCC and without MCC, respectively, are problematic, from a compliance and reimbursement perspective. Most commercial payers, including Medicare Managed Care organizations, have put these two MS-DRGs under heightened scrutiny due…
We need to stop thinking of it as copying and pasting, and have a paradigm shift to consider it copying and editing.  Last week, Shannon DeConda bemoaned the fact that we have lost the story of the encounter. She postulated that the primary impetus for this in the electronic environment…
A reader says that coders, not CDISs, are querying physicians. Across the archipelago of the Internet came a timid yelp to be heard one recent Thursday morning – and it has renewed a tsunami of interest and passion regarding the roles of coders and clinical documentation integrity specialists (CDISs). A…
Revenue is not a goal; it is an outcome. Healthcare providers, hospitals and other services, have struggled for the last decade to maintain sustainable revenue for survival. This has been exacerbated by the pandemic changing borderline net revenue to worsening losses. Many have instituted new practices to acquire more revenue…
To query or not query that is the question. Querying is the lifeline of clinical documentation integrity (CDI) professionals and many coding professionals. In fact, the CDI profession has many key performance indicators (KPIs) based on querying – so isn’t it funny that, as an industry, there is so much…
Updates are retroactive to Jan. 1, 2021. The following updates have been made via American Medical Association/Current Procedural Terminology (AMA/CPT®) editorial corrections. These corrections (errata) were posted on March 9 (published on April 1)., however, they are retroactive to Jan. 1 Underlined text indicates a change to the language instructions, and…
In January 2021, the billing guidelines changed for office and outpatient-based ambulatory services. During my interview with the C-suite occupants for my physician advisor job, I had this epiphany that the hospital gets paid, too. For those of you who do facility billing, you may not be aware that the…
CMS says the proposed rule is intended to enhance medical workforce in rural and underserved communities.  Long-awaited and eagerly anticipated the Centers for Medicare & Medicaid Services (CMS) published the proposed rule for inpatient and long-term care facilities. As in two recently proposed rule, the posting yesterday is consistent with…
ExtStore.AdvPoll.initResult(); Has the discussions over the last three weeks inspired you to writing or updating your facility coding guidelines? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-65'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Yes, started writing our guidelines 5% Yes,…
Comments on these proposed rules are due by June 7.  Hospice payment rates, as well as those for skilled nursing facilities (SNFs), constitute the subjects of two recently proposed payment rules for the 2022 fiscal year (FY)that have been issued by the Centers for Medicare & Medicaid Services (CMS). In…
Why are providers not using the new rules to their advantage? This past week, I was sitting in a new client’s office (finally!) in Georgia reviewing ear, nose, and throat (ENT) documentation. I temporarily lost my audit focus, because I started thinking back to how, at the beginning of the…
Part I in this two-part series touches on ensuring data integrity and primarily focuses on the ambulatory environment.  According to an American Medical Association (AMA) benchmark survey, the number of physicians employed by healthcare systems now exceed those remaining in private practice. Employed physicians made up 47.4 percent of all patient…
It’s not a valvular problem, but a definitional one. I recently received an email from a clinical documentation integrity (CDI) friend from my previous life as a physician advisor, asking my opinion on acute pulmonary insufficiency. She pointed out that the Association of Clinical Documentation Integrity Specialists (ACDIS) CDI handbook…
Talk Ten Tuesdays contributor Laurie M. Johnson has just about seen it all during a long career in the fields coding and consulting. EDITOR’S NOTE: Laurie Johnson is a longtime contributor to ICD10monitor and Talk Ten Tuesdays. You can hear her live reports during the latter every Tuesday at 10…
From time spent as an intern to now being the founder of a revenue cycle consulting service, Susan Gatehouse has learned the value of collaboration. To give you an idea of how much the industry has changed over the years, when I graduated in 1990, health information management (HIM) was…
Gloryanne Bryant savors her journey in healthcare and her relationship with AHIMA, explaining that what she enjoys most is growing, expanding, learning, leading, advocating, sharing, and ever importantly, volunteering, which is available to all. This is Health Information Professionals (HIP) Week, and I was asked to take some time to…
ICD10monitor contributor Rose T. Dunn has a formidable legacy as a leader in the field of coding. It was the luckiest mistake I ever made.  I am from a very small township in Pennsylvania, and my high-school counselor, like many at that time, encouraged me to go into teaching or…
Four AHIMA members tell stories of their journey into healthcare as we observe Health Information Professional (HIP) Week. ICD10monitor and Talk Ten Tuesdays are currently recognizing Health Information Professional (HIP) Week, sponsored by the American Health Information Management Association (AHIMA). As part of this recognition, we asked four of our…
Nuss Principal Procedure (ICD-10-PCS 0PS0447) Editor’s Note: This article was originally published in the American College of Physician Advisors Newsletter. IntroductionHow many times have you had a provider immediately respond, “the coding must be wrong,” when you engaged in a quality discussion? And, after you went in circles (and took several…
Facility guidelines promote data consistency. As we begin the spring season, it is a good time to update or develop new facility-specific coding guidelines. The hardest step in developing such guidelines is collecting the information necessary to write them.   There was an article in the Journal of the American Health…
Expenditures are expected to reach more than $6 trillion by 2028. Quoting from a recent press release, I noted that the Centers for Medicare & Medicaid Services (CMS) said, reflected by the below bullet points, that: Major Findings for National Health Expenditure Projection: 2019-2028: National health spending is projected to…
The worst exposure is in the airport, while you wait. Last week, my husband and I went on a post-vaccination, we-miss-being-empty-nesters vacation to use some of my airline credits I had accrued from cancelling all my speaking engagements from 2020. We had to change destinations when Georgia dropped its mask…
ExtStore.AdvPoll.initResult(); Have you reviewed the items for New Technology Add-On Payment (NTAP) and communicated to the inpatient coders which ones that should be coded for your facility? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-64'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); });…
 CMS also suspended Medicare’s FFS claims payment adjustment through December. The Centers for Medicare & Medicaid Services (CMS) announced that the suspended sequestration payment adjustment of 2 percent –  which applied to all Medicare Fee-for-Service (FFS) claims from May 1 through Dec. 31, 2020, later extended through March 21, 2021…
Dear Colleague, Please join me in recognizing the outstanding work done every day by dedicated and compassionate Health Information Professionals (HIPs). We here at ICD10monitor, and Talk Ten Tuesdays extend our sincere appreciation to those healthcare workers who toil endlessly at their stations – either on the floor, bedside, or…
Health Information Professional (HIP) Week is here, and we celebrate the tireless contributions they make in the lives of patients and providers alike, especially now during the coronavirus era— a time when, unlike any before, the focus on data is intense. And thanks to the training and education provided by…
ExtStore.AdvPoll.initResult(); How are your facility specific coding guidelines documented? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-63'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Written and available for viewing 53% Verbal 5% In process 9% No 10% Not applicable 23% ←…
Chronic or acute: questions persist in the new guidelines. You know, we have been using the new evaluation and management (E&M) guidelines for 96 days now, and if they had the ease and efficiency, we were told they had, I don’t think we would still be stumbling over the questions…
Reflections on ICD-11.    I would like to share some thoughts on ICD-11, for your consideration. First, ICD-11 is fully electronic; there will be no books. It has 17,000 diagnostic categories, and more than 100,000 medical diagnostic terms. The index-based search algorithm interprets more than 1.6 million terms. The World Health…
Current issue includes most frequently asked questions about coding COVID-19. The American Hospital Association (AHA) central office is the official United States clearinghouse on medical coding for the proper use of the ICD-10-CM/PCS systems and Level I HCPCS (CPT-4 codes) for hospital providers – and certain Level II HCPCS codes for hospitals, physicians,…
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 are required to update Medicare payment rates for different provider types, they also give us insights into the new Administration’s…
FOR IMMEDIATE RELEASE               For more information, please contact: Mike Bittner Media and Communications Manager 312-233-1087 emailProtector.addCloakedMailto("ep_8b219868", 1);emailProtector.addCloakedMailto("ep_5eb9e760", 1); Health Information Professionals Week Set for April 18-24, 2021 The American Health Information Management Association (AHIMA) will honor and celebrate health information professionals during the 32nd annual Health Information Professionals…
HIP Week is April 18 Through April 24. Health Information Professionals (HIP) Week will be recognized April 18 through April 24 according to the American Health Information Management Association (AHIMA).   It has been established that the third week in April will be HIP Week.   The theme of this year’s HIP…
There is still much to be learned about the COVID-19 associated coagulopathy. The first and ultimate reason for excellent documentation is improved patient care through clear communication between providers and an accurate picture of the patient's medical situation and treatment course. It is essential to capture all the comorbidities conditions…
IFHIMA makes the case for ICD-11 adoption with latest whitepaper. As healthcare transformation progresses due to the digitization of data and advancements in medical science and technology, it is increasingly important that nations around the world begin planning for adoption of ICD-11.  The International Classification of Diseases (ICD) has a…
This is updates an ICD10monitor story posted in September 2020. The repayment began March 30, 2021. In March 2020, the Centers for Medicare and Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 Public Health Emergency (PHE), in an effort to increase cash flow to…
March is National Nutrition Month. In honor of National Nutrition Month (March), here is a review of weight-related diagnoses. The Official Coding and Reporting Guidelines for ICD-10-CM state that other clinicians may document body mass index (BMI), but the provider must document the weight diagnosis. The BMI codes are found…
We often overlook the human component of metrics within our profession. I recently received some feedback on an article I wrote about the metrics used to measure clinical documentation improvement (CDI) performance. It reminded me that we often overlook the human component of metrics within our profession, especially when CDI…
Implementation of the Cures Act is April 5, 2021. The patient is at the center of the 21st Century Cures Act. Putting patients in charge of their health records is at the center of the U.S. Department of Health and Human Services’ (HHS's) work toward a value-based healthcare system. It is also…
ExtStore.AdvPoll.initResult(); As you think about Health Information Professionals Week, how will you celebrate? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-62'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Departmental luncheon/meal (Zoom or in person) 6% Special departmental education 1% Special departmental…
The issue is with the terminology and the coding implications. Medscape recently highlighted an article from Neurocritical Care, published March 16, by Frontera, Melmed, Fang, et al., titled Toxic-Metabolic Encephalopathy in Hospitalized Patients with COVID-19. When I read the article, alarm bells started blaring in my brain. I am writing…
Dear Colleague: The World Health Organization (WHO) gave us the International Classification of Diseases version 10 (ICD-10) and up next: ICD-11. Every day, between small tasks and major initiatives, WHO healthcare professionals are providing a huge amount of work—especially now during the global pandemic caused by the coronavirus. Their work…
Some have called this particular kind of pandemic anger, “panger!” EDITOR’S NOTE: Dr. Moffic, an internationally acclaimed psychiatrist, serves as the resident psychiatrist for Talk Ten Tuesdays. What a year it has been, as we just passed the official one-year anniversary of the advent of our viral pandemic. But it…
Understanding the impact on business processes in the event that biannual ICD-10-CM and PCS updates are implemented is essential – as is your feedback.  With a comprehensive agenda covered at the virtual ICD-10 Coordination and Maintenance Committee meeting earlier this month, one topic in particular inspired quite a few comments…
This OIG audit is an opportunity for us to be introspective. In February, a report came out from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) regarding their concern about an apparent increase in the reporting of highest-severity Medicare Severity Diagnosis-Related Groups (MS-DRGs) (Trend…
A little monitoring effort can go a long way in achieving improvement. Length of stay (LOS) continues to be examined as a metric for healthcare providers to improve. It can have positive and negative effects on both direct and indirect costs, patient care, and overhead. There is a plethora of…
ExtStore.AdvPoll.initResult(); Which diagnosis is the topic of your most frequent denial? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-61'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Sepsis 50% Encephalopathy (Metabolic or Toxic) 8% Acute Respiratory Failure 23% Acute Congestive Heart Failure…
The U.S. Department of Health and Human Services (HHS) has a new leader – thanks to the narrowest of margins. The U.S. Senate voted 50-49 Thursday to approve former California Attorney General Xavier Becerra as the nation’s top federal health official, with Democratic Sen. Mazie Horono’s abstention countered by a…
The new code is expected to be here in October. EDITOR’S NOTE: The following is the broadcast script from Dr. Erica Remer’s segment during Talk Ten Tuesdays, March 16, 2021. One of the highlights of my year, and most definitely in this past year, is participating in the ICD-10-CM Coordination and…
As vaccination rates slowly rise, federal officials are urging the pace to quicken. As COVID-19 vaccination rates slowly creep higher in jurisdictions across the country, federal officials are seeking to give the numbers a shot in the arm. The Centers for Medicare & Medicaid Services (CMS) announced Monday that this…
The three-part series is in response to listeners’ requests. The long-running live Internet broadcast Talk TenTuesdays will debut a three-part series on coding and documentation issues associated with outpatient clinical documentation integrity (CDI) today. The series, developed in response to listeners’ requests, has been developed by Colleen Deighan, a senior…
The Hospital OQR program is a pay-for-reporting quality data program for hospital outpatient services. As a coding professional with 20-plus years of coding and documentation integrity experience under my belt, I humbly recognize that I don’t know everything, and must stay curious and open to learning the ever-changing world of…
Six proposals were not heard during the Coordination and Maintenance committee meeting. The Coordination and Maintenance Committee Meeting was held March 9 – 10, 2021. The meeting began with discussion of the ICD-10-PCS topics. There were six proposals that were not discussed during the meeting which were therapeutic administration of…
ExtStore.AdvPoll.initResult(); When thinking about the Coordination and Maintenance Committee Meeting, I was surprised about: jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-60'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); New procedures 8% Minimal new codes on COVID-19 20% Changes in the…
Keeping Health Information Human Celebrate AHIMA's 32nd Annual Health Information Professionals Week April 18-24, 2021 Learn more about what ICD10monitor is doing to thank our Health Information Professionals LEARN MORE
Grieving adequately is painful, but the paradoxical outcome can be more resilience and emotional strength. I was so pleased to see that the ICD-10 Coordination and Maintenance Committee of the Centers for Disease Control and Prevention (CDC) was meeting next week, and that prolonged grief disorder was one of the…
This new law is set to take effect on Jan. 1, 2022.  In the closing days of 2020, Congress enacted and the President signed into law the "No Surprises Act."  But what does that mean for providers and patients exactly? The Act contains key protections to hold consumers harmless from…
Whether you work for a full-scale enterprise or a smaller healthcare facility, revenue integrity programs' increasing importance is consistent; beyond ensuring accurate billing and collection, these programs should strengthen reimbursement performance and provide sound financial practices. Revenue cycle management (RCM) is a well-established concept in the business of healthcare, traditionally…
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 a lot of time and effort. Sepsis is an overwhelming non-homeostatic response of the immune system to infection causing organ…
ExtStore.AdvPoll.initResult(); What part of the Coordination and Maintenance Committee Meeting do you feel is the most important? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-59'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Diagnosis 67% Procedure 24% Neither 9% ← Back
AMA says these are proposed, not finalized. The American Medical Association (AMA) Editorial Panel met in February to discuss proposed changes to the CPT® Code Book. The formal proposal published on March 5 was a reflection of the discussion, and it raised certain issues that stakeholders will now have an…
The report underscores federal authorities’ recent assertions that coding errors are generating ample unwarranted reimbursement. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) just released a data brief titled “Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged Before COVID-19 and Warrants Further…
ExtStore.AdvPoll.initResult(); How will you participate in the Coordination and Maintenance Committee Meeting? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-58'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); I will not watch or listen ever 24% Watch the recording 26% Live, but…
Two day meeting begins, March and concludes March 10, 2021 March has just arrived and in the coding world that means that the Coordination and Maintenance Committee meeting is around the corner.  The Coordination & Maintenance Committee meeting will be held virtually on March 9 and March 10 from 9:00…
Federal officials are ordering plans and insurers to cover testing without cost-sharing – for virtually any purpose. Federal officials have issued new guidance intended to streamline the process through which Americans can get easy, free access to COVID-19 diagnostic testing and/or vaccinations. “This guidance makes clear that private group health…
EDITORS NOTE: This article has been updated to include a code that should be used for an allergic reaction to vaccines. Vaccination coding and billing questions answered. COVID-19 vaccination is ramping up. We wrapped up Vaccination Nation month at the end of February. I have been fielding questions about COVID-19…
The four-part series “Vaccination Nation” concludes today with updates on vaccination rates. An already botched national COVID-19 vaccine distribution rollout has been hampered by hesitancy, suspicion, and a spate of severe winter weather that ravaged Texas and 23 states in the Southeast, forcing mass vaccination clinics to close. On the…
Pay attention to dates associated with the new COVID--19 codes, Z20.822 and Z20.828, to avoid billing errors.  In December 2020, the Centers for Disease Control and Prevention (CDC) announced six new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, developed to capture the disease process of COVID-19 better.…
Nationwide, the vaccination rollout has been uneven.The vaccine rollout in Georgia has been relatively successful thus far, although it is an evolving and ongoing process, as with most states. Per Phase 1A of the state vaccine rollout, only adults 65 and older, their caregivers, healthcare workers, employees at long-term care…
According to Bloomberg News global vaccine tracker, 5.7 percent of the U.S. population has been fully vaccinated.  I depress the plunger hard, and the retractable needle pops into the hub like magic. Just like I was told it would! This is the fourth type of needle I have used today,…
This article will pose common questions or concerns from our listeners. I am the co-host of Talk-Ten-Tuesdays because I am a national expert on clinical documentation improvement (CDI) and ICD-10, but I was first a physician who took a Hippocratic Oath to do no harm. I also have always had…
The confluence of race and heart disease. February is the month that we celebrate American Heart Month and Black History Month. You may wonder why these are being discussed together in a coding article. Heart disease is the leading cause of death for Black Americans, at 23.5 percent. Black Americans…
Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of…
We were doing our part to help facilitate making the vaccine available to the public. I was feeling confined and socially distanced due to COVID-19, as many of us are – and anxious for a vaccine so I could get back to a more normal life. I had heard about…
EDITOR’S NOTE: If projections from the Centers for Disease Control and Prevention (CDC) hold, there could be 534,000 deaths from COVID-19 by the end of February, slightly surpassing the 525,600 minutes in a year – or, put another way, one death per minute. That number – 525,600 – has been…
Vaccines are designed to prevent significant illness; they don’t prevent transmission. We are losing the war against SARS-CoV-2, the virus that causes COVID-19. More than 460,000 Americans and greater than 2.2 million people around the globe have died from it. Viruses are smart. They constantly mutate in order to “stay…
The dilemma of coding COVID-19 is revealed. One of the things that delights me about ICD-10-CM is that I find new codes (codes new to me, that is) almost daily. And I also think ICD-10-CM is pretty logical; the answers to conundrums are there, if you have faith that almost…
Everything is different, but nothing has changed. I am sure we have all heard the statement “everything is different, but nothing has changed.” There are so many versions, variations, and applications of this on the Internet, but how does it generally get interpreted? The way I see it is that…
The series will highlight the dangers of vaccination hesitancy, which is causing concern among health experts hopeful for herd immunity from COVID-19. In response to deep concern over widespread “vaccination hesitancy” – an issue the World Health Organization (WHO) says is one of the top 10 global health threats –…
Approximately 25 percent of the population is vaccine-hesitant. I’m going to get real with you: COVID-19 may very well be with us forever. We may be wearing masks or seeing our elders die from new strains of COVID-19 forever – unless enough of us get vaccinated. Herd immunity varies by…
Vaccine administration and product codes are expanding. The Centers for Medicare & Medicaid Services  (CMS) released updates to the ICD-10-PCS codes on Dec. 1, 2020, while the most recent release of CPT® codes was Jan. 25, 2021.  With the release of vaccines, the American Medical Association (AMA) has released frequent…
COVID-19 has added another level of complexity to the revenue cycle.  Hospitals and health systems need to update their current revenue cycle processes, becoming more efficient in that arena. Revenue cycle must eliminate inefficient processes in order to drive revenue preservation that translates into optimal net patient revenue. These changes…
ExtStore.AdvPoll.initResult(); Which of these responses characterizes your view on vaccination? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-57'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Already been vaccinated 47.47% Scheduled to be vaccinated 4.04% Will get vaccinated when it is available…
Alexander v. Azar Reappears; Condition Code 44 appeals could be back in court. Author’s Note: Thanks to the Center for Medicare Advocacy for alerting me to this case update. Many of you may recall a class-action lawsuit that was filed in 2011 on behalf of Medicare beneficiaries who were hospitalized…
Document coagulopathy when clinically valid and appropriate, because it reflects the seriousness of the clinical problem at hand. “Perioperative hemorrhage and hematoma,” also known as Patient Safety Indicator (PSI) 9, is one of the PSIs developed by Agency for Healthcare Research and Quality (AHRQ). PSIs are intended to provide information…
Phone call codes during the PHE range from 99441 to 99443, and are all based on time. In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) made a number of changes that allowed Medicare beneficiaries to access a wider range of telehealth services without having…
The CDI approach to PSIs should be to scrutinize the indicators for the inclusion and exclusion criteria. I believe that patient safety indicators (PSIs) serve a legitimate purpose. They are intended to “prevent potentially avoidable safety events that represent opportunities for improvement in the delivery of care.” This is a…
The vaccination effort has been suboptimal. It is mind-boggling how rapidly they were able to develop effective vaccines against COVID-19. It really was at warp speed. However, vaccines don’t protect people, vaccinations do. The vaccination effort has been suboptimal. In response to an overwhelming feeling of helplessness and depression, I…
Compliance is a big part of the risk adjustment HCC. Everyone is welcoming the New Year, and I am among them. This is a good time to take a look at some basics that make up the Medicare Advantage (MA) Risk Adjustment (RA) and Hierarchical Condition Category (HCC) model. Those…
Not all words that can be mapped within a health record to a diagnosis code are clinical documentation or reportable.   As we start 2021, it seems like a good time to get back to basics. Something that has been on my mind recently is this: do we, health information management…
Burnout in healthcare professionals, physicians in particular, was high pre-COVID. We are hearing stories every day about healthcare delivery professionals being caught up in the stress of the intense, long hours necessary to deliver care to COVID-19 patients. There have been an ebb and flow in the intensity and the…
The federal holiday honoring King is annually held on the third Monday in January. The executive body of a prominent nationwide healthcare organization has issued a formal apology for what it described as a history of racism, the announcement coinciding with the federal holiday honoring the life and work of…
In a stunning move, the U.S. Department of Health and Human Services (HHS) just announced that it is eliminating the need for providers to have a special waiver from the Drug Enforcement Administration (DEA) to prescribe medication-assisted treatment (MAT) for opioid use disorder. Approved by the Food and Drug Administration…
The principles focus on continuous improvement. There have been numerous articles and other materials written promoting the material benefits of implementing some if not all of Toyota’s 14 principles, first outlined by the auto manufacturer in The Toyota Way, published in 2001. These principles have been referred to as “a…
The conversion factor was increased twice in one week. The Centers for Medicare & Medicaid Services  (CMS), in a rare move, recently raised the  conversion factor (CF) twice in one week, resulting in an adjustment of approximately $34.89 for 2021. The action by CMS marked a last-minute slight increase to…