What could be most directly impacting reimbursement among hospitals and health systems? The problem could be, in many cases, the selection of principal diagnoses, since they drive the medical diagnosis-related groups (DRGs).For past 12 months, the health information management (HIM) consulting division at Panacea Healthcare Solutions has been conducting ICD-10 coding reviews among the nation’s…
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…
Providers nationwide have been scratching their heads for some time now over how to combat the increasingly problematic issue of clinical downgrading of diagnosis-related groups (DRGs) by auditors.Mount Sinai Health System in New York City might not have the solution – but it sure does have a game plan.The System’s…
Providers nationwide have been scratching their heads for some time now over how to combat the increasingly problematic issue of clinical downgrading of diagnosis-related groups (DRGs) by auditors.Mount Sinai Health System in New York City might not have the solution – but it sure does have a game plan.The System’s…
In my previous article, Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant, I suggested that one of the actions to prevent unjustified clinical validation denials (CVDs) is to perform concurrent clinical documentation integrity (CDI) reviews and pre-bill audits. Permit me to expound on the role of CDI reviews in…
I chose the titular subject for this article because many of us have been focusing on ICD-10-CM and PCS – and while CM is used by both inpatient and outpatient coders, we may have lost sight of CPT and HCPCS.CPT® and HCPCS education is as important as ICD-10, especially considering the…
Laurie McBriertyDee LangHolly LouieWith industry reports indicating that ICD-10 and the DRG shift are likely to cost healthcare organizations approximately one-third of their net revenue from the impact on denied claims, ICD10monitor is producing a live special edition broadcast of healthcare’s first coding summit, scheduled for May 19. The announcement was…
Given the recent extension of the ICD-10 compliance date, many hospitals are stepping back and re-evaluating project plans and timelines to use this time to improve their transition readiness.
As soon as Congress announced the latest ICD-10 implementation delay, healthcare industry leaders from across the country rallied together to face the facts (not to mention their collective disbelief and disappointment) and figure out how to move forward. First there was the April 30 ICD-10 Summit organized by the Workgroup…