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By Timothy Powell, CPA, CHCP One of the consulting engagements I once turned down was for a group of “mini” hospitals that provided emergency care in rural areas. What drove reimbursement was the fact that they refused to contract with essentially all payors, and they demanded full charges from non-contracting…
Details will be announced during the Talk Ten Tuesdays broadcast today. By Chuck Buck The American Health Information Management Association (AHIMA) is releasing a new product brief on clinical documentation integrity (CDI), with details to be revealed today during the live edition of Talk-Ten-Tuesdays. “Clinical documentation integrity (CDI) and technology…
In an unprecedented move, the Centers for Medicare & Medicaid Services (CMS) has proposed in the 2022 Outpatient Prospective Payment System (OPPS) Rule to put back on the inpatient only list all the procedures that they removed from the inpatient only list starting this calendar year. The agency has also…
EDITOR’S NOTE:  This story was originally published on RACmonitor July 15, 2021. By Stanley Nachimson, MS Some major regulations have been announced in the last few weeks. The departments of Health and Human Services (HHS), Labor, and Treasury announced the first set of rules eliminating surprise billing for commercial health…
The Centers for Disease Control and Prevention (CDC) published the ICD-10-CM Official Coding and Reporting Guidelines for the 2022 fiscal year (FY) on July 12. There are 115 pages in the new release, a decrease of 11 pages from the FY 2021 version. These guidelines become effective with Oct. 1,…
As a former manager of clinical documentation integrity (CDI) and utilization review (UR) at an academic medical center, my focus was on understanding all possible sources of revenue leakage. At that time, the UR staff focused on activities that demonstrated a patient’s medical necessity, as defined by a variety of…
Telehealth policies will lapse if something isn't done quickly, as the PHE is scheduled to end on July 21. As lawmakers are lining up to decide what Medicare will pay for after the COVID-19 public health emergency (PHE) is over, the U.S. Department of Health and Human Services Office of…
The proposed changes mark a direct effort to close health equity gaps. The Centers for Medicare & Medicaid Services (CMS) has proposed actions to close health equity gaps by providing Medicare patients battling end-stage renal disease (ESRD) with greater access to care through the ESRD Prospective Payment System (PPS) annual…