News

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…
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…