This is the second installment in my series of articles addressing clinical validation denials. Clinical validation denials (CVDs) are the derivatives of diagnosis-related group (DRG) coding validation denials. The latter is a rejection of a claim on the basis of reviewing physician documentation and determining that the correct codes or…
Before I begin, I would like to take a moment and acknowledge Dr. Robert Gold, who passed away last week. Dr. Gold was a pioneer and leader in our field of clinical documentation improvement (CDI) and coding. He was first my mentor, then my colleague, and then my friend. I…
Last week at the Health Care Payment Learning and Action Network Spring Summit, there was some great information shared with representatives of the industry.For those who don’t know about the HCP LAN, they say in order to help achieve better care, smarter spending, and healthier people, the U.S. Department of…
Laurie McBriertyDee LangHolly LouieGeorge V. Vancore, Jr.,The upcoming special edition broadcast of the industry’s first ICD-10 coding summit has been expanded to include George V. Vancore, Jr., senior manager and systems integrator and business architect for Florida Blue, the trade name for Blue Cross and Blue Shield of Florida. “We are particularly pleased…
EDITOR’S NOTE: The following is a personal reflection by the author and does not necessarily reflect the views of the Healthcare Billing and Management Association of which she is president. The story I am going to relate in this article could borrow a line from the classic 1989 comedy “When…
Recently I served as a panelist for Talk Ten Tuesdays, ICD10monitor’s weekly Internet program. The program covers a variety of topics, but ICD-10 is its primary focus.   The experience got me to thinking: we are already seeing, ICD-10 can provide us some rich data, and this directly ties to…
January 18, 2016

Good News, Bad News

To date, most accounts of ICD-10 implementation are good ones. Claims are processing, providers are being paid, denials are minimal; it was all much ado about nothing. Or was it? For some unlucky practices and organizations, things did not (and are not) going quite so well. 
Here are some lessons learned over the last year as we have prepared for an organization-wide approach to implementing ICD-10 across a very large health system in San Diego. There are three specific areas that should be considered when  implementing a new coding process for hospice programs, which went into…
Over the course of the past three years, practice management vendors have been tasked with understanding all the nuances of ICD-10, updating their applications to meet these requirements and ensuring their clients were as prepared as possible for a successful transition.  Smaller physician practices faced unique challenges as their employees…
Under ICD-10, submitting compliant and accurate claims and minimizing the negative impact to clients’ cash flow were concerns shared by all those in the coding and medical billing community. While the transition has been relatively smooth as it pertains to our internal operations, there have been unanticipated challenges on the…
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