Progress has been noted on this issue since first reported last July by ICD10monitor. Since the last Talk Ten Tuesday’s segment in August 2018 about whether HIM Coding Professionals are qualified to query for clinical validity, I am happy to announce that we are seeing some positive changes. Some organizations…
How to enhance edits to achieve clean claims. The effective use of edits within a healthcare organization’s billing system may permit such organizations to not only identify documentation, billing, and coding issues to address, but also facilitate achieving an improved clean claim rate. A clean claim is one that meets…
The mid-revenue cycle has been under-resourced. When a revenue integrity (RI) program in a healthcare enterprise is appropriately designed and implemented, providers can expect a higher clean claim rate, coding compliance, proactive identification and resolution of claim issues, and improved financial results. As Rose Dunn stated in her article “HIM’s…
HIM professionals touch many functions of the revenue cycle. As we continue this segment on health information management (HIM) in the revenue cycle, I’d like to share some thoughts I discussed at the recent Missouri Health Information Management meeting. When we think about the functions that compose the revenue cycle…
‘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…
Valerie Watzlaf, PhD returns for a second appearance tomorrow during the live broadcast. Valerie J. Watzlaf, PhD, MPH, RHIA, FAHIMA, recently elected American Health Information Management Association (AHIMA) President/Chair of the group’s 2019 Board of Directors, will be the special guest today on Talk Ten Tuesdays, according to Chuck Buck,…
These conditions should be on the radar for coding and clinical documentation integrity. There has been much discussion about healthcare expenses in recent months. The Centers for Medicare & Medicaid Services (CMS) is focusing on value-based purchasing (VBP), and payors are focused on reducing costs through Hierarchical Condition Categories (HCCs)…
Pursuing revenue cycle roles could be an ideal path for HIM professionals. Often, we see patient financial services staff progress to leadership positions in the revenue cycle. When I have the opportunity to serve in such positions, I always wonder why we don’t see more health information professionals in these…
HAC coding impacts hospital financial performance. Hospital-acquired conditions (HACs) have been reported on hospital claims since FY 2008. Payments to hospitals ranking in the lowest-performing quartile were adjusted by 1-percent reductions beginning Oct. 1, 2014. This program is known as the Hospital-Acquired Conditions Reduction Program, and it is part of…
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…