With two recent major disasters confronting caregivers, the question remains: are caregivers prone to experience PTSD than others? Exhibiting a wealth of knowledge and instinct, honed and sharpened by experience, medical first responders and emergency room professionals triage and treat thousands of emergency department (ED) patients each year in America’s hospitals.…
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…
EDITOR’S NOTE: During a recent Talk Ten Tuesday broadcast, listeners were asked “what percent of your claims are downgraded by third-party payers?” Downgrading by third-party payers occurs when the hospital-billed DRG is changed upon review by health insurance auditors to a lower-paying DRG. The majority of those who responded, over 51 percent,…
The goal was to avert fraud, waste, and abuse.We all support that – we collectively pay for Medicare, and who likes throwing their money away?Let’s review the ideal: the patient receives excellent medical care, the provider does a good job documenting that care, the coder translates the documentation into codes…
ICD-10 has been a non-event for clearinghouses, which are continuing to report little impact on their day-to-day business operations. Availity, one such entity, has encountered a few minor issues over the past month, primarily related to data not being submitted correctly by providers or payers having slightly different interpretations of…
Notably, we are in a transition phase now as it pertains to ICD-10, and getting through that phase is going to take some time, perhaps even a few months.
Not everything you read about ICD-10 is true. I know, it’s shocking. Sarcasm aside, I feel it is an important point to make since there is a lot of information floating out there about ICD-10 and it takes a level of discernment to ascertain what is the truth and what…