Friday, October 14, 2016

Horrifying Compliance Excuses!

Hi Joyce,
In my twenty years of professional work in the healthcare compliance field, I’ve heard some horrifying compliance excuses. For example, “Let’s just correct the problem moving forward, we don’t really need to go back and return money.” I was shocked the first time I heard that little doozy.
“Correcting from now on,” is a terrible attitude to have when it comes to overpayment. Is saving a little cash now worth owing millions later? Unfortunately, excuses like this are par for the course. As a compliance professional, I hear dozens of them, all the time. It’s a nightmare.
In the spirit of Halloween, download our free eBrief, "10 Compliance Horror Stories," for compliance excuses that will make you want to scream.

Trick or treat, 
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Senior Compliance Executive  |  email

Thursday, October 6, 2016

How hospitals code superbug

Has big impact on bottom line

The nuances of coding bacterial infections related to antibiotic-resistant superbugs can have a significant impact on hospital revenue streams, according to ICD10monitor.
A study published in the American Journal of Infection Control found hospital costs rose dramatically in cases where patients contracted different superbugs. Patients that contracted renal impairment increased treatment costs by an average of $8,942. 
Patients that contracted an immunocompromised status or concomitant antibiotic exposure increased treatment costs by $8,692 and $8,545, respectively.
Given the high cost of these cases and associated risk factors for contamination, ensuring correct identification, coding and nationwide tracking of superbug infections is critical, said ICD10monitor.

It is imperative hospital and physician coders stay up-to-date with changes to bacterial coding practices. 

Effective Oct. 1, codes for c. diff and MRSA changed to designate their status as hospital acquired infections. There are also ICD-10 codes for 22 different types of medication, including codes for resistance to medication, a condition that makes patient cases more difficult and costly to treat.
For more information on ICD-10 guidance updates from CMS, click here.

Sunday, September 25, 2016

What Happens on October 1st this year?!?!


Do NOT use unspecific ICD10 codes!

Your diagnosis codes will start affecting payment January 1st!

Going forward, CMS & the third-party payers are "matching" your CPT codes with ICD10 codes
to build payment policies for the future.

The codes you submit now will affect current reimbursement & FUTURE reimbursement.

Check out this video -- very interesting!

Tuesday, September 20, 2016

RN-Coder Compliance Question of the Week

Can you provide some examples of chest manipulations and the documentation required to report the applicable codes?
Chest manipulations are described in CPT with examples such as cupping, percussing and vibration to facilitate lung function by mobilization of sputum. These services must be documented as reasonable and necessary to be covered, and there must be evidence of the following:
  • Consistent with the nature and severity of the individual’s symptoms and diagnosis
  • Reasonable in terms of modality, amount, frequency and duration of treatment
  • Generally accepted by the professional community as being safe and effective treatment for the purpose used.

Tuesday, September 13, 2016

RN-Auditor COMPLIANCE Question of the Week

I have heard that the Medicare “ICD-10 flexibilities” will expire on October 1, 2016. What does this mean exactly?

According to the Centers for Medicare & Medicaid Services (CMS), ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. 

As you say, these ICD-10 medical review flexibilities will end on October 1, 2016, and providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. 

Note, however, that providers should already be coding to the highest level of specificity as this is not a new requirement.

Monday, September 5, 2016

RN-CDS Compliance Question of the Week

For the Week of September 5, 2016

What is the difference between “history of” and “follow-up” in physician documentation?

Using “history of” and “follow-up” as if they are the same is a common documentation mistake.

“History of” is often used to indicate the current clinical indication. However, in ICD-10-CM, “history of” means that the patient has a past medical condition that no longer exists and is not receiving any treatment, but has the potential for recurrence.

“Follow-up” goes along with “history of” because follow-up codes indicate continued surveillance following a completed treatment of a condition, not follow-up during treatment.

Thursday, August 25, 2016

5 Reasons Nurses Want to Leave Your Hospital

5 Reasons Nurses Want to Leave Your Hospital

Rebecca Hendren, August 9, 2011
Your nurses have one eye on the door if you do any of the following.
Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.
Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.
1. Mandatory overtime
Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.
Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.
Take a look at the last couple of years' news stories about RN picket lines. Most include complaints about mandatory overtime.