News

The allegations in the case focused on CCs and MCCs. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed in 2017, alleged that the health system submitted more than $61.8…
Changes are effective Oct. 1, 2019. It’s that time of year again! Time for the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020. And with that comes the updates to the Medicare-Severity Diagnostic Related Groups (MS-DRGs) and the complication/comorbidity and major complication comorbidity (CC/MCC) diagnosis lists. See the…
Transactional data promotes an informed and proactive environment, which leads to transformed processes.  Healthcare organizations have been on a journey to digitalization and higher efficiency for quite some time, continually investing in various technology solutions. All the while, the landscape of healthcare is only increasing in complexity, with organizations continuously…
There is an ICD-10 code for gender dysphoria. Recently, the Family Equality Council (FEC) published a comprehensive research study featuring some inspiring statistics, all of which point to the fact that the number of LGBTQ+ families in the United States is set to grow dramatically in the coming years. In…
Documentation becomes meaningful when using evidence-based medicine. I see a lot of conversations ongoing about clinical documentation integrity (CDI) efforts that in my opinion, seem to reflect a less-than-productive way of gaining progress. CDI should be about documenting for evidence-based medicine, and not coding guidelines. Coding guidelines have no place…
2019 AHIMA Clinical Documentation Improvement (CDI) Summit Summary At the American Health Information Management Association’s (AHIMA’s) recent Clinical Documentation Improvement (CDI) Summit, CDI industry experts shared insights on the most pressing issues affecting the CDI industry. Real-world examples and best practices on compliance, documentation across the healthcare continuum, clinical validation,…
Four areas where HIM professionals impact collections. I met with a coding manager recently who shared that her annual pay increase would be partially based on collections. Of course, we both looked at each other and said “why?!” But then I reflected on it and said, “why not?”  We know…
An effective query process aids the hospital’s compliance with billing/coding rules. According to the American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS), AAPC, the American Medical Association (AMA), and many other authoritative sources, a query can be a powerful communication tool used to clarify documentation in…