EDITOR’S NOTE: The following a part of a series on outpatient clinical documentation integrity (CDI). Part IV was published on May 16, 2017 in the ICD10monitor e-News.The medical record serves primarily as a physician’s communication tool for patients and all associated healthcare stakeholders. The effectiveness and completeness of the documentation…
Be adaptable and ready for change if you are responsible for payer reimbursements in your healthcare organization. The Centers for Medicare & Medicaid Services (CMS) has announced a large number of changes to diagnosis-related groups DRGs for 2018, along with changes in ICD-10-CM and PCS. Here is a quick summary…
The Centers for Medicare & Medicaid Services (CMS) and third-party auditors are going after sepsis admissions for which patients are discharged within 72 hours. It may seem preposterous, from the hospital’s perspective, that they are being allegedly unfairly targeted for payment denials for sepsis admissions. But is this actually the…
The Centers for Medicare and Medicaid Services (CMS) has released an update to the ICD-10 and Quality Measures website. The home page covers ambulatory surgical centers, hospital inpatient and outpatient, Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) Surgical Site Infections (SSI) Measures, CMS outcome and payment…
There has been a wide array of discussion through published articles, forums, webinars, and meetings about the topic of outpatient clinical documentation improvement (CDI) programs. Outpatient CDI is receiving much attention and experiencing traction in the healthcare industry due to providers coming to terms with the fact that documentation truly…
The Coordination and Maintenance Committee Meeting was held March 7-8 at the Centers for Medicare & Medicaid Services (CMS) headquarters for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) codes for the 2018 and 2019 fiscal years.Comments on the proposals for 2018 are due April 7,…
The definition of a principal procedure is part of the Uniform Hospital Discharge Data Set (UHDDS): the standard set of data elements used for inpatient billing and statistical information. It is also included in some of the core measures from the Centers for Medicare & Medicaid Services (CMS) and the…
The Coordination and Maintenance (C&M) Committee Meeting was held March 7 and 8 at the Centers for Medicare & Medicaid Services (CMS) headquarters, for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) for fiscal years 2018 and 2019. The agenda was full and required two full…
EDITOR’S NOTE: Matthew Albright oversaw the certification program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE) to ensure conformance with the requirements of the Patient Protection and Affordable Care Act (PPACA). He also served as Director of the Administrative Simplification Group…
Now that Secretary Tom Price has been confirmed to head the U.S. Department of Health and Human Services (HHS), other cabinet-level nominees are continuing through the confirmation process. Seema Verma was approved by a Senate committee and is expected to be confirmed by the full Senate as the next Centers…