Contest indicates coding accuracy is below expectations. Central Learning is a web-based coding assessment and education application. Since 2016, the company has conducted an annual national coding contest to measure ICD-10 coding accuracy and production. The initial premise was to evaluate how coding accuracy and production work, compared to ICD-9.…
The saga continues between UPMC hospitals and Highmark. UPMC reported revenue of $5.1 billion in the quarter ending March 31, 2019, up 10 percent from the $4.6 billion reported in the first quarter of last year. At the same time, expenses rose by more than 11 percent. Since revenues are…
Proposed rules also include new payment models. The Centers for Medicare & Medicaid Services (CMS) has been quite busy these last few weeks issuing the proposed payment rules for 2020 and making some other announcements.  Here is an update on other regulatory activities of interest. On April 22, 2019, the…
The FY 2020 IPPS proposed changes could bode well for many facilities. There has been much discussion about the Centers for Medicare and Medicaid (CMS) Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020 proposed rule and its suggested changes. Good news can be found in the 1,824 pages…
The Medicare Hospice Benefit proposed rule includes payment rates, wage index, and cap amount.  The Centers for Medicare & Medicaid Services (CMS) is proposing to increase hospice payments to $540 million in the 2020 fiscal year, an increase of 2.7 percent. CMS said the rate is based on the proposed…
CMS pledging improved healthcare quality and expanded access for patients. The release of the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year came with a bit of branding. “Rethinking Rural Health” and “Unleashing Innovations” were the two catchy slogans unveiled by the Centers for Medicare &…
Healthcare IT executives are monitoring interoperability decisions. EDITOR’S NOTE:  At press time, the U.S. Department of Health and Human Services (HHS) announced it is extending the public comment period by 30 days for two proposed regulations aimed at promoting the interoperability of health information technology (health IT).  The government is…
April showers bring social determinants of health flowers The showers of April have brought a burst of blooms in the Social Determinants of Health (SDoH) reimbursement garden. First, the Centers of Medicare and Medicaid Services (CMS) released its 2020 rate sheet. As expected by the industry, Medicare Advantage and Part…
‘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…
National healthcare entities are teaming up and speaking out on how to make healthcare better. EDITOR’S NOTE: The following was discussed by Nachimson during last Tuesday’s Talk Ten Tuesdays live broadcast. There are two major and complementary rules to advance interoperability being proposed by U.S. Department of Health and Human…