September 24, 2019
With late signatures, can you still bill for your medical services?
Late physician signatures pose serious issues. In the last few months, I have had questions about late signatures on documentation come in from several clients. I've been hearing about providers signing their notes a very long time after the encounter – sometimes weeks later, sometimes months, and sometimes even turning…
June 24, 2019
TPE Audits, Healthcare IT, ICD-11 Discussed at CMS
CMS provides updates and insight during the HBMA meeting. The Healthcare Business Management Association’s (HBMA) Government Relations Committee has been extremely fortunate to be invited to meet with many CMS representatives each summer. The 2019 meeting offered many insights into issues of physician and industry concern and the CMS thoughts…
December 11, 2018
ICD-10 Coding: Moderate “Conscious” Sedation vs. “Monitored” Sedation – Are you compliant?
Coders must ensure documentation supports the service, either moderate sedation or MAC. Coding moderate sedation (or conscious sedation) and monitored anesthesia care (MAC) is not difficult; however, distinguishing what the services provided are and deciphering conflicted information about which physicians can report what codes can be confusing for some coders…
July 10, 2018
The Controversy Continues: Medical Necessity versus MDM
“Medical necessity” is a much-used but often-misunderstood concept. After our recent four-part series on the “Pitfalls of an Audit” and our last Talk Ten Tuesdays segment on the series, I had taken a position on medical decision-making (MDM) of the evaluation and management (E&M) record being the overarching criteria for…
April 3, 2018
When Will Medicare Get Its Priorities Straight?
Frustrations arise over inconsistent guidance from MACs and CMS. Every single day, I get numerous email notices from the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractor (MAC) for our jurisdiction on a wide variety of “priorities:” correct coding, quality measures, new reporting initiatives, and a…
February 27, 2018
Documenting Total Knee Replacements: A Different Approach
The author believes that it is more compliant to assign total knee replacements as outpatient services and then reassess the patient’s progress the next day to determine if there is a need for inpatient status. First of all, in five years I believe what follows will all be a non…
January 15, 2018
Why Most CDI Programs Fail to Engage Physicians
CDI programs are viewed by most physicians as hospital-led initiatives geared towards increasing reimbursement for the hospital.The majority of clinical documentation improvement (CDI) programs fail to effectively engage physicians as willing participants in the push to accurately capture patient care provided through clear, concise, and contextually consistent reporting. Clinical documentation…
July 25, 2016
Good News, Bad News: The Saga Continues
The long-awaited update to the CT lung screening national coverage determination (NCD) was finally released this month. As you may recall, current smokers who were otherwise eligible were omitted from the NCD-covered codes released last year. That is the really good news. The really bad news is that at least…
April 25, 2016
ICD-10: No News, Not Good News: Report from the Trenches
What many of us are learning lately is that no news is not necessarily good news. It seems that no news about ICD-10 has simply been disguising some of the lurking problems just waiting to surface. Problems are just starting to appear as payers add edits and issues with electronic health…
January 11, 2016
Chronic Traumatic Encephalopathy (CTE) and ICD-10
In December, the movie “Concussion” was released. It tells the intriguing story of an investigation into repetitive concussion injuries and the National Football League (NFL).