News
January 29, 2019
Appealing Clinical Validation Denials in the Era of Sepsis-3
By Denise Wilson MS, RN, RRT
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…
January 22, 2019
Understanding CMS Advanced Practitioner Professional Billing
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner
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…
January 22, 2019
GAO Issues Long-Awaited Report on Patient Matching
By Julie A. Dooling, MSHI, RHIA, CHDA, FAHIMA
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…
January 22, 2019
How Public Health Crises Affect Us All
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
January 21, 2019
ICD-10: Pitfalls of Noncompliant Queries
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
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…
Interoperability is seen as the first step to using data for health improvement. I expect that 2019 will be the “Year of Interoperability”. The Centers for Medicare & Medicaid Services (CMS), through its hospital and physician incentive programs, is asking providers to have their electronic health records (EHRs) capable of…
January 15, 2019
The Changing Face of the Social Determinants of Health: Implications for Hospitals
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
Rapidly shifting societal demographics impact SDoH. 2018 saw the Social Determinants of Health (SDoH) rise to be among the most popular hot topics for the healthcare industry. In 2018 alone: $1.7 trillion in care was attributed to 5 percent of the population. ICD-10 coding reimbursement for the SDoH took place…
