New RN-Coder RN-Auditor Position

R.N. Coding Specialist / Nurse Auditor

Atlanta, Georgia

Company

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.

The Problem: 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.

Our Solution: Vatica Health pioneered the delivery of the industry’s first Provider-centric, Risk Adjustment and Quality (PRAQ^TM) 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.

Working at Vatica Health – Do You Have What It Takes?

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!

Role Description

As R.N. Coding Specialist /  Nurse Auditor, 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.

Your Responsibilities

·         Independently audit clinical documentation to ensure accuracy

·         Routinely review cases ensuring accurate ICD-10 risk-adjusted coding and clinical documentation. Opportunity to manage a team of risk-adjustment certified coders

·         Assist in making coding policy decisions for Vatica

• Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
• Share ideas that offer process improvements and train others team members, accordingly
• Maintain AACCA, AAPC CRC Certification.

 Required Experience

·         Experience working as a Registered Nurse

·         Risk adjustment coding experience (3 years) and/or the AAPC CRC certification.

·         Working knowledge of ICD-10 guidelines and appropriate clinical documentation.

·         Experience reviewing clinical cases

·         Experience with developing coding policies and helping to make coding policy decisions

Education Requirements

·         Current R.N. license  

·         Bachelor’s Degree or equivalent combination of education and experience

·         AACCA certified

·         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.

Location

·         Greater Atlanta, GA

Agency Statement

No agencies please.

Please email resume with cover letter to bmeacham@growthwright.com.

Vatica Health is an Equal Opportunity Employer.

CMS to Clear Medicare Appeals Backlog

6 things to know

Written by Ayla Ellison (Twitter | Google+)  | November 04, 2016 | Print | Email

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In an effort to help clear the backlog of Medicare appeals, CMS has offered 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.

Here are six things to know about CMS' offer.

1. Acute care hospitals and critical access hospitals are the only types of providers permitted to take part in the settlement process with CMS.

2. The settlement does not apply to any short-term hospital admissions that occurred after Oct. 1, 2013.

3. Claims subject to pending appeals before an administrative law judge or the Medicare appeals board are eligible for the settlement.

4. CMS will make the settlement process available Dec. 1. The deadline for hospitals to submit an Expression of Interest is Jan. 31, 2017.

5. CMS will host a call Nov. 16 to offer more details on the settlement process.

6. CMS made a similar offer to help clear the Medicare appeals backlog in September 2014. That settlement offer resulted in CMS paying nearly $1.5 billion to 2,022 hospitals across the nation.

100 Things to Know About Medicare Reimbursement in 2017

Written by Ayla Ellison (Twitter | Google+)  | February 08, 2017 | Print | Email

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.

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.

Inpatient hospital reimbursement1. 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.

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.

3. CMS updates the IPPS each fiscal year. CMS released the FY 2017 final rule in early August.

4. Under the FY 2017 final rule, acute care hospitals that report quality data and that are meaningful users of EHRs will receive a 0.95 percent increase in Medicare operating rates.

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.

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 three-fourths reduction of the market basket update in FY 2017.

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 strongly opposed by hospitals and sparked lawsuits challenging the payment cut.

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.

9. As part of the ACA, Medicare disproportionate share hospital payments will be reduced by 75 percent, or $49.9 billion, by 2019. 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.

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.

11. CMS removed 15 claims-based measures for the FY 2019 payment determination and subsequent years in the final rule.

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.

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.

For outpatient reimbursement & other CMS issues CLICK HERE.

Three things that can affect ICD-10 coding in 2017

by CARL NATALEJAN 3, 2017 - 08:17 PM

  

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.

New coding updates

Obviously any ICD-10-CM/PCS updates are considered developments. But I'm interested in seeing how the updates are handled.

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.

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.

Productivity

There are reports that diagnosis coding productivity is returning to ICD-9 levels. The procedural coding levels are another matter. But that is a challenge for hospitals that have resources to throw at the problem.

How productivity levels for clinicians and medical coders trend will greatly affect how ICD-10 coding is perceived.

Soon-to-be President Donald Trump

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.

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.

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.

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.

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.

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.

If Trump promises the best electronic health records (EHRs) and massive reductions in healthcare regulations and red tape, ICD-10 will work beautifully.

This could be the year that great change comes to healthcare, and ICD-10 coding stands a chance of being part of that.

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An old problem with DRG assignments

 has ICD-10 repercussions

by CARL NATALEDEC 27, 2016 - 12:01 AM

  

The Office of Inspector General (OIG) is applying greater scrutiny to a couple DRG assignments.

One focuses on mechanical ventilation. An OIG audit found a 95 percent error rate in Medicare billing 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.

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.

Why Black Friday was a Big Day for ICD10 Coding!

     www.ICD10Monitor.com 

by CARL NATALENOV 28, 2016 - 06:00 AM

  

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.

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:

• R46.1 - Bizarre personal appearance (just saying)
• W03.xx - Other fall on same level due to collision with another person (Please, watch where you're going)
• W10.0XXA - Fall on/from escalator, initial encounter (What happens on the escalator doesn't always stay on the escalator)
• W21.01 - Lack of adequate sleep (After a day of giving thanks, who got enough rest to get the best Black Friday deals?)
• W50.3XXA, Y92.512 and Y99.0 - Clerk accidentally bit by another human while at work (It's a jungle out there.)
• W51.XXXA - Accidental striking against or bumped into by another person, initial encounter (Which can cause the W03.xx.)
• W52.XXXA - Crushed, pushed or stepped on by crowd or human stampede, initial encounter (That mad rush when doors open at midnight.)
• Y04.0xxA - Assault by unarmed brawl or fight (Deep discounted appliances bring out the worst in us.)

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).

AHA pens letter to Trump calling for support of hospital policies

Written by Emily Rappleye   | November 30, 2016

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.

1. The AHA called for some regulatory trimming and pruning. 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.

2. The organization called for the President-elect's support on several financial policies. 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.

3. It asked the Trump administration to consider redesigning many quality reporting requirements. 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.

4. The AHA urged Mr. Trump to ensure access to care in his healthcare policies. 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.

5. The association also called for the preservation of value-based care models adopted under the ACA. 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.

"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.

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Compliance Question of the Week

Cardiology

For the Week of November 14, 2016

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?

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.

C9600

Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

92921

Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)

Horrifying Compliance Excuses!

Hi Joyce,

In my twenty years of professional work in the healthcare compliance field, I’ve heard some horrifying compliance excuses. For example, “Let’s just correct the problem moving forward, we don’t really need to go back and return money.” I was shocked the first time I heard that little doozy.

“Correcting from now on,” is a terrible attitude to have when it comes to overpayment. Is saving a little cash now worth owing millions later? Unfortunately, excuses like this are par for the course. As a compliance professional, I hear dozens of them, all the time. It’s a nightmare.

In the spirit of Halloween, download our free eBrief, "10 Compliance Horror Stories," for compliance excuses that will make you want to scream.
 

Download the Holiday eBrief >>

Trick or treat, 

CJ

CJ Wolf, MD, CHC, CPC, CCEP, CIA Senior Compliance Executive healthicity.com  |  email