Big ICD-10 changes coming soon to the SNF world. In July 2018, the Centers for Medicare & Medicaid Services (CMS) finalized a new case-mix classification model, the Patient-Driven Payment Model (PDPM), which, effective beginning Oct. 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS)…

How to enhance edits to achieve clean claims. The effective use of edits within a healthcare organization’s billing system may permit such organizations to not only identify documentation, billing, and coding issues to address, but also facilitate achieving an improved clean claim rate. A clean claim is one that meets…

HIM professionals touch many functions of the revenue cycle. As we continue this segment on health information management (HIM) in the revenue cycle, I’d like to share some thoughts I discussed at the recent Missouri Health Information Management meeting. When we think about the functions that compose the revenue cycle…

Pursuing revenue cycle roles could be an ideal path for HIM professionals. Often, we see patient financial services staff progress to leadership positions in the revenue cycle. When I have the opportunity to serve in such positions, I always wonder why we don’t see more health information professionals in these…

Not billing the APP service can result in serious revenue cycle errors. Many providers are still struggling with the non-physician practitioner (NPP) billing rules from the Centers for Medicare & Medicaid Services (CMS). Most facilities are now referring to NPPs as Advanced Practitioner Professionals or APPs. I get questions all…

The “right documentation” is the central pivot point to the revenue cycle   Physician clinical documentation plays a critical role in any overall healthcare delivery model, including the life of the revenue cycle, which drives reimbursement for quality medical care provided to patients. The revenue cycle is defined by the…

Each patient’s story should be told in the official record. The clinical documentation integrity (CDI) profession has only scratched the surface of instilling positive change in patterns of physician documentation and communication of patient care. There exists a myriad of opportunities for CDI specialists to capitalize upon and truly improve…

Hospital services must positively contribute to the revenue cycle and clinical documentation integrity initiatives. A recent outlook report released by Moody’s Investors Services spells continued ongoing financial challenges for non-profit hospitals next year. (Moody's Survey) The firm downgrade the sector from its current stable status to negative for 2018, attributable…

Health information management professionals are fulfilling roles in numerous healthcare settings. “Revenue integrity” is a relatively new buzz-phrase, but it certainly is a concept that should have been in practice since pay-for-service healthcare began. In essence, if it had been religiously practiced, the “fraud” would not be in the healthcare…

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…