Author Archives: Valerie Reich

DRG Audit Target Area – Multiple Significant Trauma (MST)

Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...

Coding Clinic – 4th Quarter 2018- Key Highlights

Coding Clinic 4th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a...

ICD-10 DRG Audit Target Area – Hypovolemic Shock

Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...

Proposed Model to Drive Down Prescription Drug Costs – the potential impact on providers and hospital billing

A recent proposal from the Department of Health and Human Services (HHS) is aimed at reducing prescription drug costs paid under Medicare Part B.  The proposed pricing model would gradually shift Part B payments for delineated outpatient drugs to international prices in late 2019/early 2020, starting with providers in randomly...

AHA Coding Clinic 3rd Quarter 2018 – Key Highlights

Below are highlights from Coding Clinic 3rd Quarter 2018 (effective with discharges starting September 24th). Diabetes with necrotic pressure ulcer, diabetic peripheral vascular disease and neuropathy   If a provider documents an association between diabetes and a pressure ulcer due to gangrene, the principal diagnosis is gangrene The “code first”...

Opportunity in the Data

How does your healthcare organization identify opportunity/areas of risk? Is a consistent methodology applied? Is data shared among departments? How do you loop in providers/educate? In our experience, healthcare organizations spend a lot of time and resources on the back-end revenue cycle process. With the back-end focus to drop the...

Elements of Success for Improve Quality and Shared Savings

In contradiction to Centers for Medicare & Medicaid Services (CMS) data, recent studies show that the Medicare Shared Savings Program (MSSP) has generated $1.84 billion in savings from 2013 – 2015 and reduced Medicare spending by $542 million.  How will this data impact the recent CMS proposal to overhaul MSSP...

Accountability through Auditing

Recently, the government determined that a North Carolina hospital failed to comply with Medicare billing requirements for 29% of the cases reviewed in the sample.  Using extrapolation, the government is requesting the hospital repay over $700,000 in overpayments.  In addition to the repayment, the government included other mitigation strategies that...

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Leveraging our deep operational experience and real world understanding of the regulatory landscape, Provident partners with our clients to meet the diverse challenges of the evolving healthcare industry. With proven solutions, expertise, innovative thinking, and specialized tools and techniques the Provident team works collaboratively with clients to optimize their financial and operational performance.

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