News

Recommended next steps for physician practices are discussed by the author. As you have probably heard by now, a federal judge in Texas, U.S. District Judge Reed O'Connor, on Friday, Dec. 14, 2018 struck down the Patient Protection and Affordable Care Act (PPACA) as unconstitutional, ruling that the individual mandate…
The accurate diagnosis of sepsis is not for DRG assignment. There has been quite a bit of controversy stirred up by UnitedHealthcare (UHC) and its approach to sepsis, and since I am wrapping up a fascinating targeted sepsis project, I want to share what I have learned with you. I…
Higher overturn rates noted when the appeal is filed outside of the payer’s internal appeal process.  I’d like to share some information gained from appealing over 2,000 clinical validation denials for sepsis in the state of New York since the time of the release of the Sepsis-3 criteria in February…
The code assignment is not based on clinical criteria used by the provider to establish the diagnosis. Referring to the contentious ICD-10-CM Guideline I.A.19, which indicates that assignment of a diagnosis code is based on the provider’s diagnostic statement that a condition exists, Erica Remer, MD said during Tuesday’s Talk-Ten-Tuesdays…
Not billing the APP service can result in serious revenue cycle errors. Many providers are still struggling with the non-physician practitioner (NPP) billing rules from the Centers for Medicare & Medicaid Services (CMS). Most facilities are now referring to NPPs as Advanced Practitioner Professionals or APPs. I get questions all…
The report cites the need for more work by providers. The Government Accountability Office (GAO) report on patient matching dropped last Wednesday. The industry had been waiting for the report since the 2016 passage of the 21st Century Cures Act, which included a provision for the GAO to report on…
The U.S. is in the middle of flu season this month and the opioid crisis appears unabated. There are several public health issues that are impacting the United States at the moment, and this article will focus on two of them: flu immunization and the opioid epidemic, in particular.   Have…
Noncompliant queries can be overt or subtle.The underlying hallmark of clinical documentation integrity (CDI) programs is the query process utilized to clarify documentation from a diagnosis perspective. Much emphasis is placed upon ensuring the issuing of a compliant query by the clinical documentation integrity specialists, reinforced by the American Health…