A Pittsburgh-based MD weighs in on an emerging area of focus in the healthcare industry. EDITOR’S NOTE: The following are remarks made by the author during a recent broadcast of Talk Ten Tuesdays. Today I would like to focus on outpatient clinical documentation improvement (CDI), often referred to as the…
The importance of an effective outpatient CDI program cannot be overstated When working with a member of the sales force for a previous employer, I was asked, “What is the biggest problem coders encounter?” My answer, very simply put, was “physician documentation!” I should have added “or lack thereof!” We…
It’s so important that we in the healthcare industry continue our discussion regarding the topic of Hierarchical Condition Categories (HCCs), as the risk-adjusted payment models are increasing in prevalence.The assignment of HCCs and risk adjustment has extended beyond Medicare Advantage plans as a result of the Patient Protection and Affordable…
Last week at the Health Care Payment Learning and Action Network Spring Summit, there was some great information shared with representatives of the industry.For those who don’t know about the HCP LAN, they say in order to help achieve better care, smarter spending, and healthier people, the U.S. Department of…
The implementation of ICD-10 for auto casualty has been dependent on what happens with the Centers for Medicare & Medicaid Services (CMS) and the rest of the healthcare industry.  The only states that have a dependency are states such as Pennsylvania and Florida, which use the Medicare rates for payment…
One of the most sophisticated reimbursement models in the United States involves hierarchical logic for grouping a coded health record into a designated payment group based upon the Medicare Severity Diagnosis Related Group (MS-DRG). This is the basis of payment used in the Medicare Inpatient Prospective Payment System (IPPS). The…