This OIG audit is an opportunity for us to be introspective. In February, a report came out from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) regarding their concern about an apparent increase in the reporting of highest-severity Medicare Severity Diagnosis-Related Groups (MS-DRGs) (Trend…
The report underscores federal authorities’ recent assertions that coding errors are generating ample unwarranted reimbursement. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) just released a data brief titled “Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged Before COVID-19 and Warrants Further…
Documentation of strokes is tricky. My personal provider’s MyChart has become pretty sophisticated. In preparation for an outpatient visit with my doctor, I have to review many aspects of my health history, including past medical history, medications, and allergies, and I have the opportunity to request edits. The provider must…
When I was a physician advisor, our system had a malnutrition crisis. It wasn’t that we had an explosion of unexpected cases; we were not getting the diagnosis captured when it was clinically present, relevant, and significant. When we created an electronic solution of having the provider attest to the…
Body mass index is a heavy topic. Spring has arrived in the Northeast and people are getting back to their exercise schedules. I was thinking about this topic as I was reading Coding Clinic, Fourth Quarter 2018. One of the big topics in this issue is body mass index (BMI)…
New initiative is detailed in the OIG work plan. As many of you are aware, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released a key addition to its work plan announcing an initiative to investigate and validate their concern of hospitals gaming…
CMS announced on Friday a proposed rule to expand telehealth access for patients. Hospitals, doctors, and other providers seeking an edge in today’s highly competitive healthcare environment would do well to consider a smart telehealth strategy. It’s not an option anymore to think that telemedicine doesn’t fit into your practice.…
CDI can drive down adversarial determinations of medical necessity and costly denials.  In my article published last week, titled Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement (CDI), I outlined that CDI plays a major role indeed in the context of overall healthcare…
Recent FCA activity focuses on coding compliance issues Recently in healthcare news were articles about two legal actions that cause one to reflect on the need for a strong (or stronger) coding and clinical documentation improvement (CDI) compliance programs.  The first legal action cited the False Claims Act (FCA) and…
The OIG continues to review cases of malnutrition. The diagnosis of severe protein calorie malnutrition is under high scrutiny from the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). Today, I’d like to explore the reasons…