Today my thoughts go out to the people of Texas, especially the first responders and caregivers and all of those being impacted by Hurricane Harvey. Harvey made landfall in Texas on Friday night as the strongest hurricane to hit the U.S. in more than a decade, and because it has…
This is the year of many Centers for Medicare & Medicaid Services (CMS) regulatory requirement changes. This includes the Merit-Based Incentive Program (MIPS), the next steps toward mandatory Authorized Use Criteria (AUC) implementation for advanced imaging, defining more explicitly what is and what is not “quality” care, etc.  It is…
Medicare celebrated its birthday on July 30. It was 52 years ago, on the morning of July 30, 1965, that President Lyndon Johnson signed the four-inch-thick Medicare bill into law after it had undergone more than 500 amendments during its passage through the House and Senate. The bill was signed…
The Healthcare Business Management Association (HBMA) Government Relations Committee was fortunate to have the opportunity to meet with Centers for Medicare & Medicaid Services’ (CMS) directors and Senate Ways and Means Committee staff the day the proposed rule was published.  As I think we all have recognized, the most significant changes…
Important news recently came from the Centers for Medicare & Medicaid Services (CMS) with the earlier-than-expected July 13 release of the Outpatient Prospective System (OPPS) proposed rule. The rule can be found in its entirety online at https://federalregister.gov/d/2017-14883.Per CMS, “the proposed rule would revise the Medicare hospital (OPPS) and the…
Just as we’re getting our minds wrapped around the 2,398-page Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, published by the Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016 and becoming effective Jan. 1, 2017, a new proposed rule for 2018 was published on June 20,…
The Centers for Medicare & Medicaid Services (CMS) released the 2018 ICD-10-CM files last week, exciting many in the healthcare industry. The 2018 files contain information on the ICD-10-CM coding updates for the 2018 fiscal year. These 2018 ICD-10-CM codes are to be used for discharges occurring from Oct. 1,…
EDITOR’S NOTE: The following is the second installment in a three-part series on outpatient clinical documentation integrity.In Part 1 of this series, we detailed the concept of risk adjustment and how historically, the healthcare industry rewarded volume under the fee-for-service (FFS) model. The Centers for Medicare & Medicaid Services (CMS)…
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…