Improper DRG payments in 2019 demonstrate the urgency for CDI leadership to address issues. The 2019 Medicare Fee-for-Service Supplemental Improper Payment Data Report was recently released, showing marked improvement in the Medicare improper payment rate from 2018. This year’s overall improper payment rate came in at 7.3 percent, equating to…
Today’s coder must embrace APR-DRGs and HCCs in order to stay relevant. At the beginning of the year, Facebook’s “10-year challenge” hit the web, with users posting comparison profile pictures from 2009 alongside their 2019 selfies. I’ve since seen a recent resurgence of the challenge over the last week and…
It is important to understand the data needs for your organization from a content perspective as you prepare for ICD-11. As we talk about preparing for the transition from ICD-10 to ICD-11, it is important to realize the importance of data. Healthcare data is important today for population health, determining…
EDITOR’S NOTE: This is the second portion of a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. In our second example, a 73-year-old female presented to the hospital with syncope following a fall at a physician office: The provider assigned I67.1 (Cerebral…
EDITOR’S NOTE: This is the first in a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. I shouldn’t be surprised.  I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such…
Electronic alerts for systemic inflammatory response syndrome (SIRS). EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 24 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. Dr. Ronald Hirsch recently brought an article to my attention, and I felt compelled to share…
The CDI is more than diagnosis capture through the query process. The Association for Clinical Documentation Improvement Specialists (ACDIS) recently released a paper titled Proactive CDI: Tackling the Problem of Physician Engagement, which featured six CDI leaders outlining their thoughts and ideas on facilitating physician engagement in CDI initiatives within…
The author reports on the recent court decision to dismiss a False Claims Act lawsuit against Dallas-based Baylor, Scott & White Health. EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Aug. 27 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. My…
The author shares highlights from the annual conference. I am continuing my reporting on tidbits I learned at the Association of Clinical Documentation Improvement Specialists (ACDIS) annual conference in May. As I mentioned last week, I was honored to make closing remarks on the first day. I shared my grand…
‘Déjà vu’ is a French term describing the feeling that one has lived through the present situation before.  For most health information management (HIM) professionals, many aspects of risk-adjusted coding might give rise to the phenomenon, at least as it pertains to diagnosis-related groups (DRGs)! The pandemonium regarding documentation coding…