I'm making a pitch for reciprocal education. EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. To set the stage, I am currently engaged in a really fun, intellectually challenging ongoing project. I compose…
EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesdays. The following is an edited transcript of her reporting. When I was a new physician advisor, the chief quality officer at my facility instructed me to not talk about money when discussing clinical documentation…
Case study proves the need for physicians to be members of the CDI team. Having a strong denials management team is critical for facilities. If providers do not leverage proper resources to generate strong appeal letters, the third-party payers will uphold their decisions to remove or change diagnosis or procedure…
Where CDI went awry: missing an opportunity for safety. In last week’s ICD10monitor news edition, I authored an article titled “How a Texas Health System Beat a $61.8 Million Billing Fraud Case.” The dismissal of the case was based upon a citation of previous language the Centers for Medicare &…
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…