CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. EDITOR’S NOTE: The following report first appeared on RACmonitor on July 13, 2018 After soliciting comments from many stakeholders in the last year, the Centers for Medicare & Medicaid Services (CMS) has just proposed sweeping changes…
Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The focus was on recent action by the Centers for Medicare…
“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…
Healthcare can incorporate SDoH data into daily workflows and operations. Earlier in June I wrote about that necessary marriage of costs, coding, and the Social Determinants of Health (SDoH). I was proud to be a guest on ICD10monitor’s Talk-Ten-Tuesdays to continue this dialogue. The interest and response was powerful, and…
Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you?   Editor’s Note: This is the final installment in a four-part series that examines physician documentation issues as seen by an auditor. In the last installment of this four-part series, I want to discuss the…
Risk adjustment has been used to entice payers and providers to accept patients with multiple chronic conditions along with those patients who are relatively healthy. Is coding and billing for risk adjustment really any different than what we have been doing all along? It is different in that the codes…
There will be 392 new PCS codes; eight revision titles; and 216 deleted codes.The Centers for Medicare and Medicaid Services (CMS) has released and posted the fiscal year (FY) 2019 ICD-10-PCS (procedural coding system) changes. The files contain information on the ICD-10-PCS updates for FY 2019 that all hospital inpatient…
New CMS document features gems that fill risk adjustment voids for coding rules. Coders love rules. In risk adjustment coding, we live by the Official Guidelines for Coding and Reporting, the ICD-10-CM conventions for code lookup, and the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS. Too often, though, we run…
CMS encourages providers to talk, test, and treat STDs. When it comes to sexually transmitted disease (STD) awareness, the Centers for Medicare & Medicaid Services (CMS) is encouraging providers to take three simple steps in protecting their patients through talk, testing, and treating: Talk openly about STDs with your partners…
Expansion of new ICD-10 codes has slowed. The 2019 Inpatient Prospective Payment System proposed rule covers many Medicare Severity Diagnosis-Related Groups (MS-DRGs) changes, in addition to changes to the Value-Based Purchasing (VBP), Hospital-Acquired Conditions (HACs), and Hospital Readmission Reduction program, as well as the post-acute care transfer policy. The length…