tag:blogger.com,1999:blog-62180397578599331432024-02-06T18:14:27.413-08:00RN-Coder Network USAAnonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.comBlogger101125tag:blogger.com,1999:blog-6218039757859933143.post-92228560973723627922017-03-07T14:22:00.000-08:002017-03-07T14:22:04.114-08:00New RN-Coder RN-Auditor Position<div align="center" class="MsoNormal" style="text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixP2zsiFBv5w7ixKkQF3f8U7QIW_6EqzuMOOfQQXFZsiD2Bs5srF3ROB8zi0_y4xjGDAfNbLB1NA0LMuB_gHoEtdc0yzDG2e8WRJtLaoUV-BYhUr5DYVH6yan4BB16tqBjSMJOvjm7PU8K/s1600/Vatica+Health.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="60" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixP2zsiFBv5w7ixKkQF3f8U7QIW_6EqzuMOOfQQXFZsiD2Bs5srF3ROB8zi0_y4xjGDAfNbLB1NA0LMuB_gHoEtdc0yzDG2e8WRJtLaoUV-BYhUr5DYVH6yan4BB16tqBjSMJOvjm7PU8K/s320/Vatica+Health.png" width="320" /></a></div>
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<b><span style="font-size: 14pt;">R.N. Coding Specialist / Nurse Auditor<o:p></o:p></span></b></div>
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<b><span style="font-size: 14pt;">Atlanta, Georgia<o:p></o:p></span></b></div>
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<b><span style="font-size: 10pt;">Company<o:p></o:p></span></b></div>
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<span style="background: white; font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">At Vatica Health we
are on a Mission to improve the quality of healthcare and keep populations
healthy at a lower cost. We innovate and deliver scalable, end-to-end
technology solutions and value-add clinical services that enable Providers,
Payers and Patients to THRIVE in the new world of value-based care. We are a fast growth, early stage, small
company solving today’s most complex problems with a talented team of disruptors,
inventors and change agents who are not satisfied with the status quo and crave
to make a difference. We are a ‘Powered Health’ portfolio company supported by
a network of resources, experience and industry connections.<o:p></o:p></span></div>
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<b><span style="background: white; font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">The Problem:</span></b><span style="background: white; font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> The shift to value-based care is challenging.
Providers like the infrastructure, expertise, technology, services,
payer-alignment and patient-engagement to effectively improve the cost and
quality of care.<o:p></o:p></span></div>
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<b><span style="background: white; font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Our Solution:</span></b><span style="background: white; font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> Vatica Health pioneered the
delivery of the industry’s first Provider-centric, Risk Adjustment and Quality
(PRAQ<sup>TM</sup>) solution that measures and improves care quality and
performance to accelerate the transition to value-based care. We provide
innovative technology and services that measurably improve care quality and
outcomes, payer and provider financial performance and overall population
health.<o:p></o:p></span></div>
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<b><span style="font-size: 10pt;">Working at Vatica Health – Do You Have
What It Takes?<o:p></o:p></span></b></div>
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<span style="font-size: 10pt;">We are seeking smart, hands-on,
driven, collaborative team players with a thirst for learning and quest for new
experiences to join us on our amazing ‘rocket ride’. You have an
entrepreneurial spirit that burns inside and a passion for producing amazing
work that measurably impacts our industry.
You crave the opportunity to work shoulder-to-shoulder with industry experts
to support your continual learning and customize your own career track. Our work environment is virtual – “in the
cloud” – no cubes, walls or doors. We leverage state-of-the-art technology to
communicate, collaborate and get work done - fast. We focus on results, not inputs. We are
flexible, fun and focused. If this sounds like an environment that you would
thrive in – we want to talk to you!<o:p></o:p></span></div>
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<b><span style="font-size: 10pt;">Role Description<o:p></o:p></span></b></div>
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<span style="font-size: 10pt;">As <b>R.N. Coding Specialist / Nurse
Auditor</b>, you will be part of our Risk Adjustment coding department and
routinely review cases, eventually managing a team of coders. You will also
help in making coding policy decisions for Vatica Health. This position will be based in our Atlanta,
Georgia office and will work both in the office and remotely.<o:p></o:p></span></div>
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<b><span style="font-size: 10pt;">Your Responsibilities<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Independently audit clinical
documentation to ensure accuracy<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Routinely review cases ensuring
accurate ICD-10 risk-adjusted coding and clinical documentation. Opportunity to
manage a team of risk-adjustment certified coders<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Assist in making coding policy
decisions for Vatica<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="background: white; line-height: 107%; vertical-align: baseline;"><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Continually keep abreast of technology changes, regulatory issues,
and medical practice through ongoing training and self-directed research
and share with others, accordingly<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; line-height: 107%; vertical-align: baseline;"><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Share ideas that offer process improvements and train others team
members, accordingly<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; line-height: 107%; vertical-align: baseline;"><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Maintain AACCA, AAPC CRC Certification.<o:p></o:p></span></li>
</ul>
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<b><span style="font-size: 10pt; line-height: 115%;"> </span></b><b><span style="font-size: 10pt; line-height: 115%;">Required
Experience</span></b></div>
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</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Experience working as a Registered Nurse</span><span style="font-family: Calibri, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Risk adjustment coding experience (3 years) and/or the AAPC
CRC certification.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: red; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Working knowledge of ICD-10 </span><span style="font-family: Calibri, sans-serif; font-size: 10pt;">guidelines and appropriate clinical documentation.</span><span style="color: red; font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Experience reviewing clinical cases<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Calibri, sans-serif; font-size: 10pt;">Experience with developing coding policies and helping to
make coding policy decisions<o:p></o:p></span></div>
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<b><span style="font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Education
Requirements<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Current R.N. license <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Bachelor’s Degree or equivalent
combination of education and experience<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-theme-font: minor-latin;">AACCA certified<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Must currently have AAPC CRC
certification or be willing to complete the course and become certified within
the first 3 months of employment. Vatica
will cover the cost of the certification.<o:p></o:p></span></div>
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<b><span style="font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Location<o:p></o:p></span></b></div>
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</span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-fareast-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Greater Atlanta, GA<o:p></o:p></span></div>
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<b><span style="background: white; font-size: 10pt;">Agency Statement<o:p></o:p></span></b></div>
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<span style="background: white; font-size: 10pt;">No agencies please.<o:p></o:p></span></div>
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<b><i><span style="background: white; font-size: 12pt;">Please email resume with cover letter to
<a href="mailto:bmeacham@growthwright.com">bmeacham@growthwright.com</a>.<o:p></o:p></span></i></b></div>
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<b><span style="background: white; font-size: 10pt;">Vatica Health is an Equal Opportunity Employer.<o:p></o:p></span></b></div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-48668850959895774472017-02-09T10:32:00.003-08:002017-02-09T10:32:26.585-08:00CMS to Clear Medicare Appeals Backlog<h1 class="article-title" style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; margin: 0px; padding: 0px;">
6 things to know</h1>
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<span class="author" style="color: #797979; font-size: 0.8em; font-style: italic;">Written by Ayla Ellison (<a href="https://twitter.com/@AylaEllison" style="color: #003974; text-decoration: none;" target="_blank" title="Follow Ayla Ellison on Twitter">Twitter</a> | <a href="https://plus.google.com/u/0/116407004021217686831/posts" style="color: #003974; text-decoration: none;" target="_blank" title="Follow Ayla Ellison on Google+">Google+</a>) | </span><span class="createdate">November 04, 2016 | </span><span class="print"><a href="http://www.beckershospitalreview.com/finance/cms-makes-offer-to-clear-medicare-appeals-backlog-6-things-to-know.html?tmpl=component&print=1&layout=default&page=" rel="nofollow" style="color: #003974; font-size: 1em; text-decoration: none;" title="Print article < CMS makes offer to clear Medicare appeals backlog: 6 things to know >"><span class="icon-print"></span>Print</a> |</span> <span class="email "><a href="http://www.beckershospitalreview.com/component/mailto/?tmpl=component&template=beckers&link=http://www.beckershospitalreview.com/finance/cms-makes-offer-to-clear-medicare-appeals-backlog-6-things-to-know.html" rel="nofollow" style="color: #003974; font-size: 1em; text-decoration: none;">Email</a></span></div>
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In an effort to help clear the backlog of Medicare appeals, CMS has <a href="https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Hospital-Appeals-Settlement-Process-2016.html" style="color: #003974; text-decoration: none;">offered</a> to pay hospitals 66 percent of the net allowable amount for short-term inpatient stays in exchange for hospitals dropping their pending appeals of denied claims.</div>
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Here are six things to know about CMS' offer.</div>
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1. Acute care hospitals and critical access hospitals are the only types of providers permitted to take part in the settlement process with CMS.</div>
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2. The settlement does not apply to any short-term hospital admissions that occurred after Oct. 1, 2013.</div>
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3. Claims subject to pending appeals before an administrative law judge or the Medicare appeals board are eligible for the settlement.</div>
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4. CMS will make the settlement process available Dec. 1. The deadline for hospitals to submit an Expression of Interest is Jan. 31, 2017.</div>
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5. CMS will host a call Nov. 16 to offer more details on the settlement process.</div>
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6. CMS made a similar <a href="http://www.beckershospitalreview.com/finance/cms-provides-details-on-offer-to-clear-medicare-claims-backlog-10-things-to-know.html" style="color: #003974; text-decoration: none;">offer</a> to help clear the Medicare appeals backlog in September 2014. That settlement offer resulted in CMS <a href="http://www.beckershospitalreview.com/finance/settlement-split-cms-paid-these-hospitals-nearly-1-5b-to-clear-medicare-appeals-backlog.html" style="color: #003974; text-decoration: none;">paying</a> nearly $1.5 billion to 2,022 hospitals across the nation.</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-70738859538037512052017-02-09T10:01:00.002-08:002017-02-09T10:01:10.138-08:00100 Things to Know About Medicare Reimbursement in 2017<h1 class="article-title" style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; margin: 0px; padding: 0px;">
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<span class="author" style="color: #797979; font-size: 0.8em; font-style: italic;">Written by Ayla Ellison (<a href="https://twitter.com/@AylaEllison" style="color: #003974; text-decoration: none;" target="_blank" title="Follow Ayla Ellison on Twitter">Twitter</a> | <a href="https://plus.google.com/u/0/116407004021217686831/posts" style="color: #003974; text-decoration: none;" target="_blank" title="Follow Ayla Ellison on Google+">Google+</a>) | </span><span class="createdate">February 08, 2017 | </span><span class="print"><a href="http://www.beckershospitalreview.com/finance/100-things-to-know-about-medicare-reimbursement-2017.html?tmpl=component&print=1&layout=default&page=" rel="nofollow" style="color: #003974; font-size: 1em; text-decoration: none;" title="Print article < 100 things to know about Medicare reimbursement | 2017 >"><span class="icon-print"></span>Print</a> |</span> <span class="email "><a href="http://www.beckershospitalreview.com/component/mailto/?tmpl=component&template=beckers&link=http://www.beckershospitalreview.com/finance/100-things-to-know-about-medicare-reimbursement-2017.html" rel="nofollow" style="color: #003974; font-size: 1em; text-decoration: none;">Email</a></span></div>
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Since its launch in 1965, Medicare has been one of the most influential programs for hospitals, health systems and other providers. Medicare has played a prominent part in various reform movements, including the shift from fee-for-service to value-based payment models, and the program's policies and reimbursement rates have acted as a catalyst for change nationwide.</div>
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The following list sheds some light on several facets of Medicare reimbursement, covering everything from the latest update to the Inpatient Prospective Payment System to mandatory bundled payment models.</div>
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<strong>Inpatient hospital reimbursement</strong>1. Hospitals that fall under CMS' Inpatient Prospective Payment System agree to pre-determined rates to serve Medicare beneficiaries. More than 3,300 acute care hospitals and 430 long-term care hospitals receive payments under the IPPS.</div>
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2. Hospitals generally receive IPPS payments on a per-discharge or per-case basis for Medicare beneficiary inpatient stays. Discharges are assigned to diagnosis-related groups, which sort them by similar clinical conditions and procedures administered by the hospital during the stay.</div>
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3. CMS updates the IPPS each fiscal year. CMS released the <a href="http://www.beckershospitalreview.com/finance/cms-final-ipps-rule-for-2017-9-points-to-know.html" style="color: #003974; text-decoration: none;">FY 2017 final rule</a> in early August.</div>
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<b><span style="color: blue;">4. Under the FY 2017 final rule, acute care hospitals that report quality data and that are meaningful users of EHRs will receive a <u>0.95 percent increase in Medicare operating rates.</u></span></b></div>
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5. That overall 0.95 percent payment increase reflects a positive 2.7 percent market basket update, a negative 0.3 percentage point update for a productivity adjustment, a negative 0.75 percentage point update for cuts under the ACA, a negative 1.5 percentage point documentation and coding adjustment as part of the American Taxpayer Relief Act of 2012 and an increase of about 0.8 percentage points to remove the adjustment to offset the estimated costs of the two-midnight rule.</div>
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<b><span style="color: red;">6. Hospitals that do not submit quality data lose a fourth of the market basket update (2.7 percent), and hospitals that are not meaningful users of EHRs will be subject to a <u>three-fourths reduction of the market basket update in FY 2017</u>.</span></b></div>
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7. Under the two-midnight rule, which was introduced in the 2014 IPPS rule, CMS expected a decline in the number of long observation stays and an increase in the number of inpatient admissions. CMS proposed offsetting the cost through a 0.2 percent reduction in inpatient payments. The payment reduction was <a href="http://www.beckershospitalreview.com/finance/judge-orders-hhs-to-provide-further-justification-for-two-midnight-rule-s-inpatient-pay-cut.html" style="color: #003974; text-decoration: none;">strongly opposed</a> by hospitals and sparked lawsuits challenging the payment cut.</div>
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8. CMS removed this adjustment for FY 2017 and also its effects in FYs 2014 through 2016. "CMS believes the assumptions underlying the -0.2 percent adjustment were reasonable at the time they were made," wrote CMS in the final rule. However, in light of the unique circumstances surrounding this adjustment, the agency decided to remove it.</div>
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<b>9. As part of the ACA, Medicare disproportionate share hospital payments will be reduced by 75 percent, or $49.9 billion, <u>by 2019</u>. CMS said in the FY 2017 final IPPS rule it will distribute nearly $6 billion in DSH payments in FY 2017, about $400 million less than in FY 2016.</b></div>
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10. In the FY 2017 final rule, CMS added four new claims-based measures (three clinical episode-based payment measures and one communication and coordination of care measure) for the FY 2019 Inpatient Quality Reporting Program and subsequent years.</div>
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11. CMS removed 15 claims-based measures for the FY 2019 payment determination and subsequent years in the final rule.</div>
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12. CMS made changes to the Hospital Value-Based Purchasing Program, which was established under the ACA, in the final FY 2017 rule. The agency added two condition-specific payment measures (one for acute myocardial infarction and one for heart failure) beginning in FY 2021 and a 30-day mortality measure following coronary artery bypass graft surgery beginning in FY 2022. CMS said the condition-specific payment measures capture payments for all care, including readmissions and subsequent cardiac events, across multiple care settings, services and supplies during the 30-day episode of care.</div>
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13. CMS made several changes to existing Hospital Acquired Conditions Reduction Program policies in the FY 2017 final rule, including changing the program scoring methodology from current decile-based scoring to a continuous scoring methodology.</div>
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For outpatient reimbursement & other CMS issues <a href="http://www.beckershospitalreview.com/finance/100-things-to-know-about-medicare-reimbursement-2017.html">CLICK HERE</a>.</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-151120146738724552017-01-07T08:07:00.000-08:002017-01-07T08:07:01.606-08:00Three things that can affect ICD-10 coding in 2017<h1 class="title" id="page-title" style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: RobotoDraft, sans-serif; font-size: 36px; font-stretch: inherit; font-variant-numeric: inherit; font-weight: 300; line-height: 40px; margin: 13px 0px 0px; padding: 0px; vertical-align: baseline;">
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<img alt="Three things that can affect ICD-10 coding in 2017" class="featured_image" height="240" src="http://www.icd10watch.com/sites/icd10watch.com/files/styles/featured_image/public/ICDbaby_420.jpg?itok=Snr9YOOk" style="-webkit-appearance: none; border: 0px; box-shadow: none !important; box-sizing: border-box; float: left; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto !important; line-height: inherit; margin: 7px 20px 0px 0px; max-height: 240px; max-width: 365px; padding: 0px; vertical-align: baseline; width: 365px;" typeof="foaf:Image" width="365" /><div class="field field-name-body field-type-text-with-summary field-label-hidden" style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
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U.S. healthcare has been using ICD-10-CM/PCS coding for more than a year so there doesn't seem like anything new could happen. But there are three things that might make their marks on the code sets.</div>
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New coding updates</h3>
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Obviously any ICD-10-CM/PCS updates are considered developments. But I'm interested in seeing how the updates are handled.</div>
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Healthcare providers are going to panic because the 2017 ICD-10 updates set them back (which we do not know yet) or they will yawn because they have coding systems that tackle the new codes without creating hassles.</div>
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If the latest updates don't throw healthcare providers out of sorts, it's possible physicians will appreciate the new granularity they wanted to be able to document on medical claims.</div>
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Productivity</h3>
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There are reports that <a data-mce-="" href="http://journal.ahima.org/2017/01/01/three-him-stories-to-watch-for-in-2017/" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">diagnosis coding productivity is returning to ICD-9 levels</a>. The procedural coding levels are another matter. But that is a challenge for hospitals that have resources to throw at the problem.</div>
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How productivity levels for clinicians and medical coders trend will greatly affect how ICD-10 coding is perceived.</div>
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Soon-to-be President Donald Trump</h3>
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This isn't meant as an insult, but it is doubtful that President-elect Donald Trump knows what ICD-10 coding is. Very few successful and intelligent people outside of healthcare do. So he probably has no opinion on what should happen to it.</div>
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But he has nominated Rep. Tom Price to lead Department of Health and Human Services (DHHS). Price never has been a fan of ICD-10 coding. He has co-sponsored anti-ICD-10 bills.</div>
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But it's hard to imagine Price asking Congress to revert U.S. healthcare back to ICD-9 coding. That would create more havoc and cost than the original ICD-10 transition. Besides, he's going to be busy reimagining Obamacare and reforming Medicaid.</div>
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By the way, I predict in 2018 I will have to write posts explaining why we still have ICD-10 coding despite the repeal of Obamacare.</div>
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But whatever Trump and Price come up for healthcare, they're going to want to target waste and fraud. Politicians love to campaign against waste and fraud. So it would be a great idea to create a healthcare system that pays for benefits by eliminating waste and fraud.</div>
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Someone could persuade Trump that ICD-10 coding will be a great tool to identify the waste and fraud. That could be more persuasive than physician complaints about how onerous and burdensome this ICD-10 mandate is.</div>
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If Trump promises the best electronic health records (EHRs) and massive reductions in healthcare regulations and red tape, ICD-10 will work beautifully.</div>
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This could be the year that great change comes to healthcare, and ICD-10 coding stands a chance of being part of that.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-55085501379712397992016-12-28T20:48:00.001-08:002016-12-28T20:48:36.965-08:00Pssst . . . . NEWYEAR2017 code saves you $500 offRN-Coder COMBO Pkg - that's only $333 <i>per program!</i><br />
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<i>This extra special offer expires New Years Day! DO NOT WAIT - </i>Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-32070205108314681182016-12-28T20:41:00.000-08:002016-12-28T20:41:06.929-08:00An old problem with DRG assignments<h1 class="title" id="page-title" style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: RobotoDraft, sans-serif; font-size: 36px; font-stretch: inherit; font-variant-numeric: inherit; font-weight: 300; line-height: 40px; margin: 13px 0px 0px; padding: 0px; vertical-align: baseline;">
has ICD-10 repercussions</h1>
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<span class="author-name" style="border: 0px; box-sizing: border-box; display: block; float: left; font-family: inherit; font-size: 12px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: 25px; margin: 0px; padding: 0px; vertical-align: baseline;">by <span style="border: 0px; box-sizing: border-box; color: #776e6e; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; text-transform: uppercase; vertical-align: baseline;">CARL NATALE</span></span><span class="post-date" style="border-bottom-color: initial; border-bottom-style: initial; border-image: initial; border-left-color: rgb(191, 191, 191); border-left-style: solid; border-right-color: initial; border-right-style: initial; border-top-color: initial; border-top-style: initial; border-width: 0px 0px 0px 1px; box-sizing: border-box; color: #776e6e; display: block; float: left; font-family: inherit; font-size: 12px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 25px; margin: 0px 0px 0px 15px; padding: 0px 0px 0px 15px; text-transform: uppercase; vertical-align: baseline;">DEC 27, 2016 - 12:01 AM</span></div>
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<img alt="An old problem with DRG assignments has ICD-10 repercussions" class="featured_image" height="240" src="http://www.icd10watch.com/sites/icd10watch.com/files/styles/featured_image/public/calmcode_420.png?itok=xJ0IFBsU" style="-webkit-appearance: none; border: 0px; box-shadow: none !important; box-sizing: border-box; float: left; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto !important; line-height: inherit; margin: 7px 20px 0px 0px; max-height: 240px; max-width: 365px; padding: 0px; vertical-align: baseline; width: 365px;" typeof="foaf:Image" width="365" /><div class="field field-name-body field-type-text-with-summary field-label-hidden" style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
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The Office of Inspector General (OIG) is applying greater scrutiny to a couple DRG assignments.</div>
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One focuses on mechanical ventilation. An <a data-mce-="" href="http://www.fortherecordmag.com/archives/1216p24.shtml" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">OIG audit found a 95 percent error rate in Medicare billing</a> from 2009 to 2011. That isn't an ICD-10 problem. The problem has existed long before ICD-10 implementation. But if there is greater scrutiny of medical ventilation diagnoses, healthcare providers need to make sure they nail the right assignments of ICD-10 codes and DRGs.</div>
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It underscores the need for healthcare providers to continue training. Their medical coders need to know more than just new codes. They need to understand the rule and guidelines. The correct application is as tricky and important as it every was.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-15141874603836388642016-12-05T05:00:00.000-08:002016-12-28T20:43:53.761-08:00Why Black Friday was a Big Day for ICD10 Coding!<h4 style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: RobotoDraft, sans-serif; font-stretch: inherit; font-variant-numeric: inherit; font-weight: 300; line-height: 40px; margin: 13px 0px 0px; padding: 0px; vertical-align: baseline;">
<span style="font-size: 36px;"><img alt="Carl Natale" class="headshot" src="http://www.icd10watch.com/sites/icd10watch.com/files/styles/author_headshort_59x59/public/MrCarl_60_0_0.jpg?itok=uFMcvQe2" height="59" style="-webkit-appearance: none; border-radius: 50%; border: 0px; box-shadow: none !important; box-sizing: border-box; color: #444444; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto; line-height: inherit; margin: 0px; max-width: 100%; padding: 0px; vertical-align: baseline;" typeof="foaf:Image" width="59" /> </span><span style="font-size: large;"><a href="http://www.icd10monitor.com/">www.ICD10Monitor.com</a> </span></h4>
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<img alt="Why Black Friday was a big day for ICD-10 coding" class="featured_image" src="http://www.icd10watch.com/sites/icd10watch.com/files/styles/featured_image/public/ICD101_81.jpg?itok=nh2Td8Q0" height="240" style="-webkit-appearance: none; border: 0px; box-shadow: none !important; box-sizing: border-box; float: left; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto !important; line-height: inherit; margin: 7px 20px 0px 0px; max-height: 240px; max-width: 365px; padding: 0px; vertical-align: baseline; width: 365px;" typeof="foaf:Image" width="365" /><br />
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After processing the Thanksgiving Day calamities, it would be nice to get a break. Except Black Friday isn't known as a day of recuperation.</div>
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The good news is that most of the possible diagnoses will come from one section of the ICD-10-CM code set. The bad news is this:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">R46.1</strong> - Bizarre personal appearance (just saying)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W03.xx</strong> - Other fall on same level due to collision with another person (Please, watch where you're going)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W10.0XXA</strong> - Fall on/from escalator, initial encounter (What happens on the escalator doesn't always stay on the escalator)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W21.01</strong> - Lack of adequate sleep (After a day of giving thanks, who got enough rest to get the best Black Friday deals?)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W50.3XXA, Y92.512 and Y99.0</strong> - Clerk accidentally bit by another human while at work (It's a jungle out there.)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W51.XXXA</strong> - Accidental striking against or bumped into by another person, initial encounter (Which can cause the W03.xx.)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">W52.XXXA</strong> - Crushed, pushed or stepped on by crowd or human stampede, initial encounter (That mad rush when doors open at midnight.)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Y04.0xxA</strong> - Assault by unarmed brawl or fight (Deep discounted appliances bring out the worst in us.)</li>
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After all of that, it seems like the safest strategy is to avoid the crowds and do the shopping online. But there's always G56.00 (carpal tunnel syndrome).</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-23188773744899945202016-12-01T10:22:00.002-08:002016-12-01T10:22:28.519-08:00AHA pens letter to Trump calling for support of hospital policies<h4 style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; margin: 0px; padding: 0px;">
Written by Emily Rappleye | <span class="createdate" style="font-size: 17px;">November 30, 2016</span></h4>
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The letter called on Mr. Trump not to make any abrupt changes or to repeal the ACA without a replacement plan, and it outlined the following five areas of healthcare policy for Mr. Trump to consider."To help advance health in America, we ask that your administration — in collaboration with Congress and the courts, and in partnership with healthcare providers — help modernize the public policy environment to enhance providers' ability to improve care and make it more affordable for patients," wrote Richard Pollack, president and CEO of AHA.</div>
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<strong>1. The AHA called for some regulatory trimming and pruning. </strong>They specifically called for the elimination of Stage 3 meaningful use for hospitals, implementation of a penalty for high rates of incorrect denials under the Recovery Auditor Contractor program, protection of clinical integration arrangements under the Anti-Kickback Statute, standardization of the Federal Trade Commission's merger review process and elimination of several post-acute care regulations.</div>
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<strong>2. The organization called for the President-elect's support on several financial policies. </strong>These include addressing drug prices, protecting the 340B Drug Pricing Program, challenging mergers among payers and considering Medicare reforms, such as raising the eligibility age.</div>
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<strong>3. It asked the Trump administration to consider redesigning many quality reporting requirements. </strong>The AHA wrote that requirements are excessive, redundant and not always meaningful. Notably, it called for suspension of the hospital star ratings on the Hospital Compare website.</div>
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<strong>4. The AHA urged Mr. Trump to ensure access to care in his healthcare policies. </strong>Particularly, the hospital association pointed to continued funding for CHIP, expanded mental health services, elimination of site-neutral payment cuts and establishment of a permanent Veterans Choice Program, which allows veterans to access care outside of the VA health system.</div>
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<strong>5. The association also called for the preservation of value-based care models adopted under the ACA. </strong>The AHA asked that several models be updated, including several ACO requirements and the advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act.</div>
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"We look forward to working with you and your administration on public policy solutions to achieve our vision of a society of healthy communities where all individuals reach their highest potential for health," Mr. Pollack concluded.</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-40451923036935592592016-11-29T19:14:00.001-08:002016-11-29T19:14:04.707-08:00Don't Wait! $1499 RN-Coder COMBO Ends Nov. 30th!<div align="center">
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-52487629325906194932016-11-14T12:50:00.002-08:002016-11-14T12:50:33.629-08:00Compliance Question of the Week<h1 style="background-color: #fafcfb; color: #499fbc; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 1.8em;">
Cardiology</h1>
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<a href="http://www.panaceainc.com/cardiology-archive/1879-for-the-week-of-november-14-2016.html" style="color: #28758e; font-size: 14.04px; outline-style: none; text-decoration: none;">For the Week of November 14, 2016</a></h2>
<div class="question">
If the doctor places a drug-eluting stent (DES) in the left anterior descending (LAD) artery and also does an angioplasty only of a diagonal artery, would the appropriate coding for a Medicare patient be C9600 and 92920 or C9600 and 92921?</div>
<div class="answer">
<br />
If a DES is placed in the LAD, and separate angioplasty of a diagonal is performed, you would report the codes listed below. The angioplasty is in an additional branch of the LAD.<br />
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<tr><td style="width: 70px;" valign="top">C9600</td><td>Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch</td></tr>
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<tr><td style="width: 70px;" valign="top">92921</td><td>Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)</td></tr>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-75352101677154228832016-10-14T16:15:00.002-07:002016-10-14T16:15:54.358-07:00Horrifying Compliance Excuses!<div class="m_123117826508960414hs_cos_wrapper m_123117826508960414hs_cos_wrapper_widget m_123117826508960414hs_cos_wrapper_type_rich_text" id="m_123117826508960414hs_cos_wrapper_email_content" style="background-color: white; color: inherit; font-family: "Century Gothic", CenturyGothic, AppleGothic, sans-serif; font-size: inherit; line-height: inherit;">
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Hi Joyce,</div>
<div style="margin-bottom: 1em;">
In my twenty years of professional work in the healthcare compliance field, I’ve heard some <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*N1CND78CMYTfV_LLXW3pc5Dr0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxx-h20Xbg0W682YBL1hsrhvW7FR0hs28Wy5pW7lhYjl7g_ntNW6WjjFh1LcNCnW1bJ4l96Xj6YxW1W_vbH6vw0NqW7MzVpB7FPjrcW1Cr7H37qX_pvW22VX3G7Txp_WW1lkYvG67PPlcW6Dp67G1sCVlpW3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1MlS4Hzl-Vf16zzQL11&source=gmail&ust=1476571820097000&usg=AFQjCNEF03dJYbBu3ee8hbS3GLhxVuUuiQ" href="http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*N1CND78CMYTfV_LLXW3pc5Dr0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxx-h20Xbg0W682YBL1hsrhvW7FR0hs28Wy5pW7lhYjl7g_ntNW6WjjFh1LcNCnW1bJ4l96Xj6YxW1W_vbH6vw0NqW7MzVpB7FPjrcW1Cr7H37qX_pvW22VX3G7Txp_WW1lkYvG67PPlcW6Dp67G1sCVlpW3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1MlS4Hzl-Vf16zzQL11" style="color: #1155cc;" target="_blank">horrifying compliance excuses</a>. 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.</div>
<div style="margin-bottom: 1em;">
“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.</div>
<div style="margin-bottom: 1em;">
In the spirit of Halloween, download <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*N394fh135VyTN2QCsfPCwvbl0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxxZJ2hJsmPW72nd1T7v5N2hW6PC41T19CPcyW5T8tfM7hYyK_W2fVdQp2bTGlcW1wc5Zj84v6mzW1PlxrK1vrWJ3W7NJ1gR1-dLqRW6xDWGm20SDlhW7kVp2b20Q71FW29Tq4V80nZrYW1ZVmRH89F8L3W3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1Mm74HzlZvf69GWSQ11&source=gmail&ust=1476571820097000&usg=AFQjCNEllPJ07QZOk9ZfL1M62D0_TKVCMw" href="http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*N394fh135VyTN2QCsfPCwvbl0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxxZJ2hJsmPW72nd1T7v5N2hW6PC41T19CPcyW5T8tfM7hYyK_W2fVdQp2bTGlcW1wc5Zj84v6mzW1PlxrK1vrWJ3W7NJ1gR1-dLqRW6xDWGm20SDlhW7kVp2b20Q71FW29Tq4V80nZrYW1ZVmRH89F8L3W3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1Mm74HzlZvf69GWSQ11" style="color: #1155cc;" target="_blank">our free eBrief</a>, "10 Compliance Horror Stories," for compliance excuses that will make you want to scream.<br /> </div>
<div style="margin-bottom: 1em;">
<a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*VckFgH97NK0LW1YSFxN57fy4w0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxy0G1T62MSW1FcdBl2cZMhZW7NzSvD85MTykW6yDsQl7NKjHGW7MLcYZ6Jy1prW6TtR0F5-0NNbW1N4zqL785SxCW2d1MYs6k3WtKW28Ng121L6B_LW7F0jkw7bd734W7bZhFn7YvySSW1WkNnc6kNWbdW3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1Ml_4Hzl-Gf1C23kV11&source=gmail&ust=1476571820097000&usg=AFQjCNHF0eyqDqCqbL8IbaPARpZRqirnOQ" href="http://www.healthicity.com/e1t/c/*W4NvSnl8KW5m_W8H3zwF7Hc18x0/*VckFgH97NK0LW1YSFxN57fy4w0/5/f18dQhb0SfHr9dsQ84W4j2KBY5VQHwrW6btZp75klwZMW4R4D5n57mvC2W1BQYgz8Tm-BbW7NQGvY57QNp2W5lFVhT9cYnQ0W7P2jb65ZpMqqW4B8b1h5Tb8GxW3M0H8l6dgN-YW2-s9l141XfsYW2-CVz14Bs6cnW4yym9n2p0tdzW5Q4rYS6HqvD5W6Hv0N21S3j8gVfG23Y3y1S8nW6FTsJW1JwQ7lW7D0j0l8zhd8SW2ZJL7j7FPMfFW1Xf6lM3yJQPyW3741l85bPQ0kW7v4x2t5kFBKfW7lYt775s7-x9W7z2NMJ7vRb8yW2dg9JK1GgGq8W1YYV5x72nt_yW6sxy0G1T62MSW1FcdBl2cZMhZW7NzSvD85MTykW6yDsQl7NKjHGW7MLcYZ6Jy1prW6TtR0F5-0NNbW1N4zqL785SxCW2d1MYs6k3WtKW28Ng121L6B_LW7F0jkw7bd734W7bZhFn7YvySSW1WkNnc6kNWbdW3G_1lT6l4G-zMPs031gkKmyW5qjwml3L-_YgW2sRmRx2c12n3VMb0vx1Ngx1cW51bpnf4lK-z3W7Z5bN01MPNGZW87tqb38TXm5GVG-MB4978vMGW4L1Ml_4Hzl-Gf1C23kV11" style="color: #1155cc;" target="_blank">Download the Holiday eBrief >></a></div>
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Trick or treat, </div>
<div style="margin-bottom: 1em;">
CJ</div>
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<tr><td align="left" colspan="2" style="margin: 0px;"><span style="color: #646464; font-family: "Century Gothic", CenturyGothic, AppleGothic, sans-serif; font-size: 10pt; font-weight: bold;">CJ Wolf</span><span class="m_123117826508960414req_all" style="display: inline;"><span style="color: #646464; font-family: "Century Gothic", CenturyGothic, AppleGothic, sans-serif; font-size: 8pt;">, <span class="m_123117826508960414fill">MD, CHC, CPC, CCEP, CIA</span></span></span></td></tr>
<tr><td align="left" colspan="2" style="margin: 0px; padding-top: 0px;"><span class="m_123117826508960414req_all" style="display: inline;" title="true"><span style="color: #ff3d4d; font-family: "Century Gothic", CenturyGothic, AppleGothic, sans-serif; font-size: 8pt;">Senior Compliance Executive</span></span></td></tr>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-12720516247872016412016-10-06T17:02:00.002-07:002016-10-06T17:02:25.022-07:00How hospitals code superbug<h1 class="article-title" style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; margin: 0px; padding: 0px;">
Has big impact on bottom line</h1>
<div class="article-meta" style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin: 0px; padding: 0px;">
<span class="author" style="color: #797979; font-size: 0.8em; font-style: italic;">Written by Brooke Murphy | </span><span class="createdate">October 04, 2016</span><span class="email"></span></div>
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<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
The nuances of coding bacterial infections related to antibiotic-resistant superbugs can have a significant impact on hospital revenue streams, according to <a href="http://www.icd10monitor.com/enews/item/1709-coding-the-superbugs-keeping-up-with-change" style="color: #003974; text-decoration: none;" target="_blank">ICD10monitor</a>.</div>
<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
A study published in the <em>American Journal of Infection Control</em> 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. </div>
<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
Patients that contracted an immunocompromised status or concomitant antibiotic exposure increased treatment costs by $8,692 and $8,545, respectively.</div>
<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
<b><i>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,</i></b> said ICD10monitor.</div>
<h2 style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
It is imperative hospital and physician coders stay up-to-date with changes to bacterial coding practices. </h2>
<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
<b><i><u>Effective Oct. 1, codes for c. diff and MRSA changed to designate their status as hospital acquired infections.</u></i></b> 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.</div>
<div style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 17px; margin-bottom: 1em; margin-top: 1em; padding: 0px;">
For more information on ICD-10 guidance updates from CMS, click <a href="https://www.cms.gov/medicare/coding/icd10/index.html" style="color: #003974; text-decoration: none;" target="_blank">here</a>.</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-57738796695855745832016-09-25T14:29:00.001-07:002016-09-25T14:29:08.987-07:00What Happens on October 1st this year?!?!END OF MEDICARE ICD10 "GRACE PERIOD".<br />
<br />
<a href="https://youtu.be/Lp9a-SGZVm4">https://youtu.be/Lp9a-SGZVm4</a><br />
<br />
Do NOT use unspecific ICD10 codes!<br />
<br />
Your diagnosis codes will start affecting payment January 1st!<br />
<br />
Going forward, CMS & the third-party payers are "matching" your CPT codes with ICD10 codes<br />
to build payment policies for the future.<br />
<br />
The codes you submit now will affect current reimbursement & FUTURE reimbursement.<br />
<br />
Check out this video -- very interesting!Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-10208331441491509582016-09-20T09:34:00.001-07:002016-09-20T09:34:31.834-07:00RN-Coder Compliance Question of the Week<div class="page-header" style="background-color: #fafcfb; color: #5f5f5f; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
<h1 style="color: #499fbc; font-size: 1.8em;">
Respiratory</h1>
</div>
<div class="page-header" style="background-color: #fafcfb; color: #5f5f5f; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
<h2 itemprop="name" style="color: #3a7f96; font-size: 14.04px;">
For the Week of September 19, 2016</h2>
</div>
<div itemprop="articleBody" style="background-color: #fafcfb; color: #5f5f5f; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
Can you provide some examples of chest manipulations and the documentation required to report the applicable codes?<br />
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:<br />
<ul>
<li style="margin-left: 1em;">Consistent with the nature and severity of the individual’s symptoms and diagnosis</li>
<li style="margin-left: 1em;">Reasonable in terms of modality, amount, frequency and duration of treatment</li>
<li style="margin-left: 1em;">Generally accepted by the professional community as being safe and effective treatment for the purpose used.</li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-16060234511101893782016-09-13T10:32:00.003-07:002016-09-13T10:32:49.988-07:00RN-Auditor COMPLIANCE Question of the Week<div class="page-header" style="background-color: #fafcfb; color: #5f5f5f; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
<h2 itemprop="name" style="color: #3a7f96; font-size: 14.04px;">
For the Week of September 12, 2016</h2>
</div>
<div itemprop="articleBody" style="background-color: #fafcfb; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
<b><span style="color: red;">I have heard that the Medicare “ICD-10 flexibilities” will expire on October 1, 2016. What does this mean exactly?</span></b><br />
<div style="color: #5f5f5f;">
<br /></div>
<div style="color: #5f5f5f;">
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. </div>
<div style="color: #5f5f5f;">
<br /></div>
<div style="color: #5f5f5f;">
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. </div>
<div style="color: #5f5f5f;">
<br /></div>
<div style="color: #5f5f5f;">
<b><i><u>Note, however, that providers should already be coding to the highest level of specificity as this is not a new requirement.</u></i></b></div>
</div>
Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-47507766246592413202016-09-05T10:47:00.001-07:002016-09-05T10:47:59.483-07:00RN-CDS Compliance Question of the Week<div class="items-leading" style="background-color: #fafcfb; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 15px;">
<div class="leading-0">
<h2 style="color: #499fbc;">
<a href="http://www.panaceainc.com/general-archive/1774-for-the-week-of-september-5-2016.html" style="color: #28758e; font-size: 14.04px; outline-style: none; text-decoration: none;">For the Week of September 5, 2016</a></h2>
<div class="question">
<b><span style="color: blue;">What is the difference between “history of” and “follow-up” in physician documentation?</span></b><br />
<div style="color: #5f5f5f;">
<br /></div>
</div>
<div class="answer" style="color: #5f5f5f;">
Using “history of” and “follow-up” as if they are the same is a common documentation mistake.<br />
<br />
“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.<br />
<br />
“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.<br />
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<div class="item-separator" style="color: #5f5f5f;">
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-86095402517501610842016-08-25T18:16:00.001-07:002016-08-25T18:16:01.663-07:005 Reasons Nurses Want to Leave Your Hospitalhttp://www.healthleadersmedia.com/nurse-leaders/5-reasons-nurses-want-leave-your-hospital<br />
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<h1 style="box-sizing: inherit; margin: 0px;">
5 Reasons Nurses Want to Leave Your Hospital</h1>
</div>
<div class="group-details field-group-div" style="background-color: white; box-sizing: inherit; color: #232222; font-family: "Open Sans", sans-serif; font-size: 17.5px; font-weight: 600; line-height: 1; margin: 0px 0px 5px;">
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Rebecca Hendren, <span class="pub-date" style="box-sizing: inherit; color: #ba1f38;">August 9, 2011</span></div>
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<advertisement style="box-sizing: inherit;"></advertisement></div>
<div style="box-sizing: inherit; margin-bottom: 10px; margin-top: 10px;">
Your nurses have one eye on the door if you do any of the following.</div>
<div style="box-sizing: inherit; margin-bottom: 10px; margin-top: 10px;">
Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. <a href="http://www.healthleadersmedia.com/content/HR-268421/Nurse-Retention-Strategies-a-Growing-Priorit" style="background: transparent; box-sizing: inherit; color: #008ed8; text-decoration: none; transition: all 0.3s ease;">A recent survey from healthcare recruiters AMN Healthcare</a> 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.</div>
<div style="box-sizing: inherit; margin-bottom: 10px; margin-top: 10px;">
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.</div>
<div style="box-sizing: inherit;">
<b style="box-sizing: inherit;">1. Mandatory overtime</b></div>
<div style="box-sizing: inherit; margin-bottom: 10px; margin-top: 10px;">
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.</div>
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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.</div>
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Take a look at the last couple of years' news stories about RN picket lines. Most include complaints about mandatory overtime.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-21266947286856505082016-08-14T13:32:00.000-07:002016-08-14T13:32:08.514-07:00ICD10CM Updates for 2017Effective October 1, 2016:<br />
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Deleted 2017 ICD-10-CM Codes</h2>
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The following 311 ICD-10-CM codes will be deleted in the 2017 ICD-10-CM code set, effective October 1, 2016.</div>
<ul style="background-color: white; box-sizing: border-box; font-family: Verdana, Geneva, sans-serif; font-size: 13px; line-height: 18.5714px; margin-bottom: 9px; margin-top: 0px;">
<li style="box-sizing: border-box;">Page 1/2: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/Deleted_Codes/2017/1" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">D49.5</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">T85.83XA</span></a></li>
<li style="box-sizing: border-box;">Page 2/2: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/Deleted_Codes/2017/2" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="background: transparent; box-sizing: border-box; color: blue; font-family: Consolas, monaco, monospace; font-size: 14px; text-decoration: none;">T85.83XD</span><span style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box;"> to </span></span><span class="identifier" style="background: transparent; box-sizing: border-box; color: blue; font-family: Consolas, monaco, monospace; font-size: 14px; text-decoration: none;">Z98.89</span></a></li>
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New 2017 ICD-10-CM Codes</h2>
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The following 1,974 ICD-10-CM codes will be added to the 2017 ICD-10-CM code set, effective October 1, 2016.</div>
<ul style="background-color: white; box-sizing: border-box; font-family: Verdana, Geneva, sans-serif; font-size: 13px; line-height: 18.5714px; margin-bottom: 9px; margin-top: 0px;">
<li style="box-sizing: border-box;">Page 1/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/1" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">A92.5</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">E13.3419</span></a></li>
<li style="box-sizing: border-box;">Page 2/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/2" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">E13.3491</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">I69.910</span></a></li>
<li style="box-sizing: border-box;">Page 3/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/3" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">I69.911</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">M97.21XA</span></a></li>
<li style="box-sizing: border-box;">Page 4/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/4" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">M97.21XD</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">R82.79</span></a></li>
<li style="box-sizing: border-box;">Page 5/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/5" style="background: transparent; box-sizing: border-box; color: #0000b3; outline-offset: -2px; outline: -webkit-focus-ring-color auto 5px;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">R93.41</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S02.80XD</span></a></li>
<li style="box-sizing: border-box;">Page 6/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/6" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S02.80XG</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S99.131A</span></a></li>
<li style="box-sizing: border-box;">Page 7/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/7" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S99.131B</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">T83.512D</span></a></li>
<li style="box-sizing: border-box;">Page 8/8: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/New_Codes/2017/8" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="background: transparent; box-sizing: border-box; color: blue; font-family: Consolas, monaco, monospace; font-size: 14px; text-decoration: none;">T83.512S</span><span style="color: blue;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box;"> to </span></span><span class="identifier" style="background: transparent; box-sizing: border-box; color: blue; font-family: Consolas, monaco, monospace; font-size: 14px; text-decoration: none;">Z98.891</span></a></li>
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Revised 2017 ICD-10-CM Codes</h2>
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The following 425 ICD-10-CM codes have desciption changes in the 2017 ICD-10-CM code set, effective October 1, 2016.</div>
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<li style="box-sizing: border-box;">Page 1/2: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/Revised_Codes/2017/1" style="background: transparent; box-sizing: border-box; color: #0000b3; outline-offset: -2px; outline: -webkit-focus-ring-color auto 5px;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">C7A.094</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S49.039D</span></a></li>
<li style="box-sizing: border-box;">Page 2/2: ICD-10-CM <a href="http://www.icd10data.com/ICD10CM/Revised_Codes/2017/2" style="background: transparent; box-sizing: border-box; color: blue; text-decoration: none;"><span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">S49.039G</span> to <span class="identifier" style="box-sizing: border-box; font-family: Consolas, monaco, monospace; font-size: 14px;">T85.690S</span></a></li>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-55612730429669353712016-08-14T10:14:00.000-07:002016-08-14T10:14:30.305-07:00<div class="heading-container heading-resize " style="animation: animatedBackground 40s linear infinite; background: url("../images/heading-bg-skyblue.png") center top no-repeat scroll rgb(62, 178, 230); box-sizing: border-box; color: #565656; font-family: proxima-nova, Helvetica, Arial, sans-serif; font-size: 14.5px; letter-spacing: 0.05px; line-height: 24.65px; overflow: hidden; position: relative; width: 1349px;">
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ICD-10 Denials Increase for Practices</h1>
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ICD-10 – a diagnostic coding system developed by the World Health Organization, is in its early implementation stages, and it has already caused the health care organizations to cope with a number of challenges arising due to poor education and preparation regarding ICD-10. Poor education regarding this new coding system has led to a number of consequences, including compliance issues, claim rejections, coding backlogs, delays, and denials.</div>
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In this article, we will be discussing how implementation of ICD-10 has led to increased number of denials and what an organization can do to limit the impact of this new coding system on its denial rates.</div>
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ICD-10 Denial Rate Forecast</h3>
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The health IT industry, has published white papers predicting that the implementation of ICD-10 will lead to a 100 to 200 percent increase in claim rejection and/or denial rates.</div>
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Explaining that during the post-implementation phase of ICD-10, healthcare organizations may experience significant impact on the length of time and amount of rework required for claim rejects and their productivity. Practices may suffer a negative impact of ICD-10 on their cash flow and revenue due to lost productivity and increasing number of coding errors.</div>
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The companies recommended that organizations should measure their denial rates and types of rejects or denials during the transition phase in order to plan and act accordingly.</div>
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<li style="box-sizing: border-box;">Of 4.6million claims submitted every day, only 2 percent were rejected because of invalid or incomplete data.</li>
<li style="box-sizing: border-box;">About 0.09 percent claims were rejected due to invalid ICD-10 codes.</li>
<li style="box-sizing: border-box;">About 0.11 percent claims were rejected due to invalid ICD-9 codes.</li>
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3 Most Common ICD-10 Denials</h3>
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The implementation of ICD-10 can prove to be a bumpy ride for your practice if you haven’t done enough preparation. In order to gain maximum benefit from this transition and to minimize denial rates, it is important that you act proactively.</div>
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To help you do so, we are listing 3 most common ICD-10 denials and ways to avoid them.</div>
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<li style="box-sizing: border-box;"><em style="box-sizing: border-box;">“Diagnosis Code: Invalid; Diagnosis code must be most specific.”</em></li>
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The new ICD-10 coding system provides specific codes for specific condition. In order to avoid denials due to unspecific codes, select the most specific code for each condition and claim.</div>
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<li style="box-sizing: border-box;"><em style="box-sizing: border-box;">“Diagnosis Code: Invalid; Must be a valid ICD-10-CM diagnosis code.”</em></li>
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Denials that specify the above reason can be caused by a number of issues. In order to avoid these denials, choose the most specific and valid ICD-10 code that rightly represents the patient’s documented condition.</div>
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<li style="box-sizing: border-box;"><em style="box-sizing: border-box;">“Diagnosis Code: Invalid; Claim cannot contain a mixture of ICD-9 and ICD-10 codes.”</em></li>
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In order to avoid claim denials due to this reason, make sure that the outpatient claim contains either ICD-10 or ICD-9 codes.</div>
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The best way to handle ICD-10 rejections and denials is to stay proactive. Educate your staff on how documentation and procedures may affect denial and rejection rates. Learn from the denials and establish best practices on how to prepare proper medical claims.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-69501641999134172722016-08-14T10:12:00.002-07:002016-08-14T10:12:27.813-07:00Why clinical documentation is the missing link<h1 class="article-title" style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 1.6em; line-height: 1.1em; margin: 0px; padding: 0px;">
to value-based reimbursement</h1>
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<span class="author">Written by Emily Rappleye (<a href="https://twitter.com/@Emily_BHR" style="color: #1965c3; text-decoration: none;" target="_blank" title="Follow Emily Rappleye on Twitter">Twitter</a> | <a href="https://plus.google.com/u/0/106215421892789587456/posts" style="color: #1965c3; text-decoration: none;" target="_blank" title="Follow Emily Rappleye on Google+">Google+</a>) | </span><span class="createdate">August 10, 2016</span></div>
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The key to successfully making the jump from the old era of healthcare — one where fee-for-service is king — to the new era of healthcare — one where transparency, consumerism and value dominate — may actually be as simple as improving clinical documentation, according to Anthony Oliva, DO, vice president and CMO of Nuance Healthcare.</div>
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"For those who thought, 'Maybe we can just hold out and [value-based care] will all go away,' it's never going to go away; it's only going to get worse," Dr. Oliva said at the Becker's 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago.</div>
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Healthcare is a classic example of a model explained in Ian Morrison's book <em>The Second Curve</em>, according to Dr. Oliva. This two-curve model posits that any market undergoing transformation has two curves: the old and the new. Companies must ride the first curve and learn how and when to jump to the second, Mr. Morrison explains in the book.</div>
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In healthcare, the first curve was designed around the provider, according to Dr. Oliva. This is because the provider had control over the entire healthcare economy and was able to dictate supply and demand. On the first curve is a carefully controlled entry of physicians into the market, according to Dr. Oliva. On this curve, physicians are able to exert absolute control over demand, too. The attitude was, "Cut my fees by 5 percent and I'll just see 5 percent more people," Dr. Oliva said.</div>
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Now this fee-for-service world is being challenged by cost controls, informed consumers and transparency, and it is flipping the power dynamic to a second curve. The trouble is that physicians need to understand how to make the leap to the second curve — value-based care — and remain financially stable.</div>
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One of the big changes in the second curve is newly found transparency, according to Dr. Oliva. Patients can go online and not only find information about diseases and medical treatments, but also find information about the quality of care their hospitals or even their individual physicians provide.</div>
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"In the past, quality was really determined for the most part by the relationship you had with your physician," Dr. Oliva said. "We never knew whether a physician was good or bad. How would you know that a physician is practicing in a standard of care that's acceptable for his or her specialty? We did a lot of assuming."</div>
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Now not only are quality outcomes tied to reimbursement by CMS, but the transparency of information magnifies this change because patients can go online and compare physician performance. These physician transparency tools — Dr. Oliva named ProPublica's <a href="https://www.propublica.org/article/surgeon-level-risk-short-methodology" style="color: #1965c3; text-decoration: none;" target="_blank">Surgeon Scorecard</a> as an example — use Medicare billing information to compare physician performance.</div>
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"We see that the connection is vital between what the physician writes in the record to what's billed to insurance companies and Medicare," he said. This means a physician won't be properly reimbursed — or accurately scored on public scoring systems — if he or she is not properly documenting the severity of his or her patients.</div>
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This makes clinical documentation improvement essential to landing the jump from the first curve to the second curve in healthcare. Dr. Oliva advised attendees not to take their clinical documentation improvement programs for granted. "If you look at it as a severity capture program first, the revenue will take care of itself," he said.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-66970018418761408762016-08-11T16:22:00.000-07:002016-08-11T16:22:29.841-07:00DEVELOPING: CMS Releases 2017 ICD-10-PCS Codes<div class="catItemHeader" style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13.4px;">
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<span class="catItemAuthor" style="color: #999999; display: inline !important; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13.4px; margin: 0px; padding: 0px;">Written by <a href="http://www.icd10monitor.com/enews/special-bulletin/itemlist/user/4354-lauriemjohnsonmsrhiacpchfahima" rel="author" style="color: #2f79b6; text-decoration: none;">Laurie M. Johnson, MS, RHIA, CPC-H, FAHIMA</a> </span><span style="font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13.4px;">|</span><span style="font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13.4px;"> </span><span class="catItemDateCreated" style="color: #999999; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 11px;">Friday, 03 June 2016 00:00</span></h3>
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<img border="0" src="http://www.icd10monitor.com/images/stories/bwpix/l-johnson.jpg" style="border: none; float: left; margin: 10px;" />The Centers for Medicare and Medicaid Services (CMS) released the 2017 ICD-10-PCS codes as well as other supporting documentation on Thursday.<br />
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Before you get excited, the 2017 ICD-10-CM codes have not been released yet. The additional supporting documentation includes the 2017 ICD-10-PCS Official Coding and Reporting Guidelines, the addenda for the ICD-10-PCS Index and Tables, a text listing of the 2017 procedure codes with the file layout description, the order file which includes the long and short descriptions of the 2017 procedure codes, and a conversion table for the 2016 to 2017 codes.<br />
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The update also states that the following documents will not be updated beyond 2016: The ICD-10-PCS Reference Manual, the document describing the development of the ICD-10 Procedure Coding System (ICD-10-PCS), and the ICD-10 Procedure Coding System Power Point slides.<br />
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The long-awaited 2017 ICD-10-PCS codes are 75,789 in number. The new codes are found in the Medical and Surgical, Administration, Measurement and Monitoring, Extracorporeal Therapies, and New Technology sections. The highest number of changes is in the Medical and Surgical section, which now totals 65,676 codes. The Administration section has 39 changes, which increases the number of codes to 1,427. Extracorporeal Therapies section adds four new codes to increase the total to 46. The New Technology section has added 27 new codes which give us a glimpse into the procedures, devices, and substances that will be approved for New Technology add-on payments to MS-DRG v34.<br />
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The biggest changes include the revision of the definitions of root operations Control and Crea<br />
tion, new root operation “Perfusion,” which was added to the Extracorporeal Therapies section, and changing the body part terminology in the Heart and Great Vessels Body System. The coronary arteries will now be identified by the number of <strong><span style="text-decoration: underline;">arteries</span></strong> treated and not sites. This change is supported in the 2017 ICD-10-PCS Coding and Reporting Guidelines. The new definition of Control is stopping, or attempting to stop, post-procedural or other acute bleeding. This revision now includes “other acute bleeding,” which may be based on the clinical documentation. The new definition of Creation is putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part which has changed the focus of this root operation from only sex-change operations to operations in other body systems. The new root operation of Perfusion is defined as extracorporeal treatment by diffusion of therapeutic fluid.<br />
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The 2017 ICD-10-PCS Official Coding and Reporting Guidelines were developed based on the internal review of the 2016 version and public input. The areas that have been revised include B2.1a, B3.2, B3.4a, B3.6b, B3.6c, B3.7, B3.9, B4.2, and B4.4. Guideline B2.1a revision provides an alternative when clinical documentation is not present and the coder may use the general anatomic region as an unspecified code. The expectation is that this option will be used rarely. B3.2 (Multiple procedures) has been altered in the examples of this guideline. B3.4a adjusted the spacing for the provided examples. B3.6b and B3.6c adjusted the guideline to match the changes from coronary sites to coronary arteries in the Tables. B3.7 added “other acute bleeding” to reflect the change in the definition of root operation Control. B3.9 addresses the excision of an autograft. This guideline change provides more information to other body part value. This change includes “different procedure site” rather than other body part value. This revision will assist the coders to determine if a separate code should be reported. B4.2 adds information regarding cardiovascular structures that could have branches and how to assign a code when the specific artery or vein is not available in the correct table, but a general body part is available. The provided example of this guideline is the occlusion of the bronchial artery being coded to the body part value Upper Artery in the body system Upper Arteries, and not to the body part value Thoracic Aorta, Descending in the body system Heart and Great Vessels. Guideline B4.4 addresses coronary arteries as a body part value. As discussed earlier, coronary arteries as body parts are a big change for the 2017 version. The change involves a switch from the number of sites treated to the number of coronary arteries treated.<br />
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The first update to the ICD-10-PCS codes is finally here! The link to the new files for ICD-10-PCS is provided below. The industry continues to look for the 2017 ICD-10-CM codes and most importantly, MS-DRG v34.<br />
Resources: <a href="https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html" style="color: #2f79b6; text-decoration: none;">https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html</a></div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-36590499555614932682016-02-29T15:32:00.006-08:002016-02-29T15:32:59.175-08:00LA Department of Health latest ransomware victim<h1 style="background-color: white; color: #000099; font-family: Arial, Helvetica, FreeSans, sans-serif; font-size: 26px; line-height: 30px; margin: 17px 0px 0px; padding: 0px;">
<span style="font-size: 14px; line-height: 18px;">February 29, 2016 | By</span><span style="font-size: 14px; line-height: 18px;"> </span><a href="http://www.fiercehealthit.com/author/Susan%20D.%20Hall" rel="author" style="color: #000099; font-size: 14px; line-height: 18px; text-decoration: none;" title="View author profile.">Susan D. Hall</a></h1>
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<a href="http://www.fiercehealthit.com/node/50066" style="color: #000099; text-decoration: none;" target="_blank"><img align="right" alt="" src="http://assets.fiercemarkets.net/public/healthit/cyber_security.jpg" style="border: 0px none; float: right; height: 135px; margin: 8px; width: 180px;" /></a><br />
The Los Angeles County Department of Health Services has been targeted in a ransomware attack, just days after Hollywood Presbyterian Medical Center paid about $17,000 to hackers who left employees <a href="http://www.fiercehealthit.com/story/hollywood-presbyterian-medical-center-takes-systems-offline-due-ransomware/2016-02-16" style="color: #000099; text-decoration: none;" target="_blank">without access to systems for more than a week</a>, reports the <em>Los Angeles Times.</em><br />
At the LA health department, remnants of a ransomware thread were found on five work computers last Wednesday, but the attack did not affect operations, spokesman Michael Wilson <a href="http://www.latimes.com/local/lanow/la-me-ln-county-health-services-ransomware-20160226-story.html" style="color: #000099; text-decoration: none;" target="_blank">told</a> the <em>LA Times</em>. The malware did not spread and the network was not compromised, he added.<br />
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The incident was reported to the Los Angeles County district attorney's office and the county's chief information office, and Wilson said the country will not pay the ransome.<br />
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While often the source of a ransomware attack is unknown, Turkish hackers have recently claimed credit for the Hollywood Presbyterian attack. They vowed to keep up attacks as long as the U.S. government continues to support Kurdish rebels,<a href="http://www.ibtimes.com/turkish-hackers-claim-credit-hollywood-hospital-ransomware-attack-2327065" style="color: #000099; text-decoration: none;" target="_blank">according to</a> the <em>International Business Times.</em><br />
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Health systems in the U.S. are not the only victims in the recent growth of ransomware incidents. At least two German hospitals also have come under attack, <a href="http://www.theregister.co.uk/2016/02/26/german_hospitals_ransomware/" style="color: #000099; text-decoration: none;" target="_blank">according</a><a href="http://www.dw.com/en/hackers-hold-german-hospital-data-hostage/a-19076030?maca=en-rss-en-all-1573-rdf" style="color: #000099; text-decoration: none;" target="_blank"> to</a> <em>DW.com</em>. IT officials at Lukas Hospital in Germany's western city of Neuss took systems down after noticing unusual pop-up warnings and the network running slowly. Malware infected systems at Klinikum Arnsberg hospital in the German state of North Rhine-Westphalia apparently through a booby-trapped email attachment.<br />
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Security experts have previosuly predicted a <a href="http://www.fiercehealthit.com/story/phishing-ransomware-attacks-health-industry-rise/2014-12-10" style="color: #000099; text-decoration: none;" target="_blank">rise in ransomware attacks</a>. Last month, <a href="http://www.fierceemr.com/story/texas-hospitals-ehr-system-suffers-ransomware-attack/2016-01-27" style="color: #000099; text-decoration: none;" target="_blank">Mount Pleasant Texas-based Titus Regional Medical Center's electronic health record system was left inaccessible by such an attack</a>.<br />
Experts have also said <a href="http://www.fiercehealthit.com/story/report-ransomware-attacks-med-devices-real-possibility-2016/2015-11-25" style="color: #000099; text-decoration: none;">attackers could use ransomware to target medical devices</a>.<br />
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To learn more:<br />- here's the <em>LA Times</em> <a href="http://www.latimes.com/local/lanow/la-me-ln-county-health-services-ransomware-20160226-story.html" style="color: #000099; text-decoration: none;" target="_blank">article</a><br />- read the <em>Register</em> <a href="http://www.theregister.co.uk/2016/02/26/german_hospitals_ransomware/" style="color: #000099; text-decoration: none;" target="_blank">story</a><br />- check out the<em> International Business Times</em> <a href="http://www.ibtimes.com/turkish-hackers-claim-credit-hollywood-hospital-ransomware-attack-2327065" style="color: #000099; text-decoration: none;" target="_blank">piece</a></div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-60127700449678715292016-02-24T23:16:00.001-08:002016-02-24T23:16:56.388-08:00New Threat to Clinical Documentation<div class="itemHeader" style="background-color: white; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 13.4px;">
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<span class="itemAuthor" style="color: #999999; display: inline !important; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 13.4px; margin: 0px; padding: 0px;">by <a href="http://www.icd10monitor.com/enews/itemlist/user/4354-lauriemjohnsonmsrhiacpchfahima" rel="author" style="color: #2f79b6; text-decoration: none;">Laurie M. Johnson, MS, RHIA </a></span><span style="font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 13.4px;">|</span><span style="font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 13.4px;"> </span><span class="itemDateCreated" style="color: #999999; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 11px;">Monday, 22 February 2016 </span></h3>
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<img border="0" src="http://www.icd10monitor.com/images/stories/bwpix/l-johnson.jpg" style="border: none; float: left; margin: 10px;" />On Feb. 5, Hollywood Presbyterian Medical Center experienced an electronic health record (EHR) outage that began due to ransomware. This type of malware had shut down the hospital’s internal computer system and communication devices, with only a software “key” capable of reopening the internal data files. The hospital has reported that patient care was not compromised at any time or in any way. <br />
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Hollywood Presbyterian returned to paper registrations and documenting on paper forms throughout the incident. The emergency department and fax machines were some areas that were affected by the hacking, however. <br />
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The hospital released a statement on Feb. 17 noting that it had paid the ransom of 40 bitcoins, or approximately $17,000, in order to obtain the decryption key and return the operations to normal as soon as possible. Bitcoin is a type of digital currency that is difficult to trace. Operations were restored on Feb. 15.<br />
Hollywood Presbyterian Medical Center notified law enforcement immediately, and the Federal Bureau of Investigation (FBI) is now involved with the case. Computer experts assisted the facility in getting their health information systems back online and in understanding the event. According to a memo released by the hospital’s president, Allen Stefanek, “we have no evidence at this time that any patient or employee information was subject to unauthorized access.”<br />
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This incident raises the importance of backup systems, redundancy, security, and information governance. Could a hacker invade an electronic health record and impact patient care? Could a hospital be shut down permanently? How do security measures need to change in order to keep our health information safe? <br />
February is Information Governance Month. You may wonder, “what is information governance?” This American Health Information Management Association (AHIMA) initiative is focused on protecting and maintaining high quality of data and integrity of all types of data. As we have learned in recent years, data is very important in the healthcare industry to providing high quality of care, a safe environment, and cost-effective treatment. Information is an asset to any organization that must be kept safe and secure. We need information governance so that we can extract clinical and business information and optimize its usefulness. <br />
Health information management (HIM) professionals have always understood the importance of data security and consistent data. As healthcare delivery becomes more electronic in nature, the need for security and management will become heightened.<br />
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This cyberattack highlights the need to remain diligent in our security practices to protect the most personal of information – our health records.<br />
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<strong>About the Author</strong><br />
Laurie Johnson, MS, RHIA, FAHIMA is the director of health information management (HIM) consulting services for Panacea Health Solutions Inc. She has conducted ICD-10 education sessions and documentation reviews for multiple organizations. Prior to working for Panacea, Laurie worked for Peak Health Solutions and Optum.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-85626000346152551642016-02-05T11:30:00.000-08:002016-02-05T11:30:03.983-08:00$25 billion in ICD-10 claims already!<div class="group-title-line field-group-div" style="background-color: white; box-sizing: border-box; color: #333333; font-family: fira-sans, Helvetica, Arial, sans-serif; font-size: 16px; line-height: 19.2px;">
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RelayHealth counts $25 billion in ICD-10 claims already</h2>
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Firm predicts "groundswell of issues," including increased denials and rejections</div>
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By <a href="http://www.healthcareitnews.com/author/henry-powderly" style="background: transparent; box-sizing: border-box; color: #3e88df; font-family: fira_sansbold; line-height: 2.345; text-decoration: none;">Henry Powderly</a><div class="field field-name-sharethis-top-block field-type-ds field-label-hidden" style="box-sizing: border-box; float: right; padding-right: 0px;">
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<span class="st_email_custom" displaytext="email" st_processed="yes" st_title="RelayHealth counts $25 billion in ICD-10 claims already" st_url="http://www.healthcareitnews.com/news/relayhealth-logs-25-billion-icd-10-claims-though-payment-issues-still-not-known" style="background: url("/sites/all/themes/hitn_theme/images/sprite_social-article.png") 0px -137px / cover no-repeat; box-sizing: border-box; cursor: pointer; display: block; float: left; height: 40px; margin-left: 5px; width: 40px;"></span></div>
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Revenue cycle firm RelayHealth said that ICD-10 claims "are flowing succesfully," to the tune of approximately $25 billion thus far. </div>
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<span style="box-sizing: border-box; font-size: 1em; line-height: 1.5;">"Now the industry must be ready to tackle the next set of challenges: timely and correct reimbursement," said Joshua Berman, ICD-10 Lead for RelayHealth, in the announcement. Berman added that <a class="directory-item-link" href="http://www.healthcareitnews.com/directory/relayhealth-0" style="background: transparent; box-sizing: border-box; color: #3e88df; font-family: fira_sansbold; text-decoration: none;" target="_blank">RelayHealth</a> will be tracking closely days until final bill, an important metric that will signal just how disruptive the code change is to the industry.</span></div>
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According to RelayHealth's <a href="https://icd10central.relayhealth.com/#!/advisor" style="background: transparent; box-sizing: border-box; color: #3e88df; font-family: fira_sansbold; text-decoration: none;">ICD10Central</a> website, days until final bill has averages 14.8 days since the Oct. 1, but most of those claims were coded in ICD-9. There are still a few weeks until the wave of ICD-10 claims begin to be paid.</div>
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In an earlier announcement, Berman discussed what he saw on Oct. 1.</div>
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"RelayHealth saw about five million institutional claims pass through the clearinghouse. Only around 50,000, or .01 percent, of these claims were coded ICD-10. As of October 5, the ICD-10 volume grew to approximately 4 percent (or about one million claims) -- still a small part of the volume. The jump on professional claims (physician billing) was more significant; increasing from 1 percent to 36 percent. in the same timeframe," he said."</div>
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"We did see a one day decrease in Days to Final Bill from 14.8 to 13.6 days, which is counterintuitive to what you may expect post-ICD-10 deadline and likely due to a hard push to get to get ICD-9 claims completed."</div>
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Berman, however, said troubles with ICD-10 could be felt soon.</div>
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"As the majority of providers -- representing a majority of the healthcare dollars -- move fully to ICD-10, post-ICD-10 technical claims are released, and the time for expected remittances arrives, we continue to anticipate a groundswell of issues in getting claims out the door and an increase in denials and rejections."</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0tag:blogger.com,1999:blog-6218039757859933143.post-35069271589180770082016-01-27T14:17:00.000-08:002016-01-27T14:17:05.656-08:00How is ICD-10 affecting claim denials?<h1 class="title" id="page-title" style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: RobotoDraft, sans-serif; font-size: 36px; font-stretch: inherit; font-weight: 300; line-height: 40px; margin: 13px 0px 0px; padding: 0px; vertical-align: baseline;">
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<img alt="How is ICD-10 affecting claim denials?" class="featured_image" height="240" src="http://www.icd10watch.com/sites/icd10watch.com/files/styles/featured_image/public/stethescopecash_450_2.jpg?itok=Y4So8O3Q" style="-webkit-appearance: none; border: 0px; box-shadow: none !important; box-sizing: border-box; float: left; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto !important; line-height: inherit; margin: 7px 20px 0px 0px; max-height: 240px; max-width: 365px; padding: 0px; vertical-align: baseline; width: 365px;" typeof="foaf:Image" width="365" /><span class="print-link" style="border: 0px; box-sizing: border-box; display: block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px 0px 0.5em; text-align: right; vertical-align: baseline;"></span><div class="field field-name-body field-type-text-with-summary field-label-hidden" style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
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There are some mixed messages on how much claim denials have risen since Oct. 1.</div>
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Some healthcare providers are reporting a <a data-mce-="" href="http://coalitionforicd10.org/2016/01/19/two-weeks-and-counting-coalition-members-report-on-icd-10-implementation/" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">few ICD-10 denials but not enough</a> to worry about. On the other hand, a healthcare consultant found out that a California HMO was denying medical claims on a massive scale. And NCDs and LCDs have needed tweaks to prevent mistaken denials.</div>
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If this isn't a major national problem, it certainly can be a major problem for individual medical practices. So it needs to be fixed.</div>
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First, <a data-mce-="" href="http://www.icd10watch.com/blog/icd-10-metrics-are-we-looking-right-indicators" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">measure ICD-10 claim denials and monitor revenue-based metrics</a>. It is important to understand where the problems are occurring. Then medical practices can start fixing the problems that create denials.</div>
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Second, figure out <a data-mce-="" href="http://www.icd10watch.com/blog/where-find-some-icd-10-coding-answers" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">if the right ICD-10 codes are being used</a>. There is lots of room for error so make sure the medical claims are coded correctly and clinical documentation supports the diagnoses. Keep investing in coding training.</div>
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Third, keep calling the healthcare payers until they answer questions. Do not let any denial go because it's too much work.</div>
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Best advice: Prevent denials</h3>
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Chris Nerney at Revenue Cycle Insights identifies <a data-mce-="" href="http://www.revenuecycleinsights.com/news/focusing-these-3-things-can-help-providers-prevent-claims-denials" style="background: 0px 0px; border: 0px; box-sizing: border-box; color: #330099; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">three things that can help healthcare providers prevent claims denials</a>:</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Registration processes:</strong> Denial problems can start before the first ICD-10 code is recorded.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Medicaid:</strong> Which comprises 13 percent of all denials. Start by checking eligibility, medical necessity and pre-authorization.</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">High-impact specialties:</strong> Specialties contribute heavily to major amounts of claim denials. (Repeat the advice in the first two tips).</li>
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In a way, the macro claim denial statistics don't matter as much as the individual anecdotes. Those stories are valuable examples of how to solve denial issues.</div>
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Anonymoushttp://www.blogger.com/profile/01710463095486867408noreply@blogger.com0