Insights

Telehealth Services – Proactively Assess Your Risk

In a recent review of telehealth services, the Office of Inspector General (OIG) found approximately one-third (31/100) of the claims reviewed did not meet Medicare telehealth requirements.  Of the 31 cases, the majority were noncompliant because the patients received care in a location not considered “rural.”  Institutions/facilities that provide telehealth...

Being Proactive in 2018

At the end of 2017, the U.S. Department of Justice (DOJ) issued its annual recovery statistics – more than $3.7 billion in total recoveries. Of the $3.7 billion recovered, $2.4 billion were associated with settlements and judgements from the healthcare industry. With another record year on the books, healthcare organizations...

Recouping Inpatient Revenue

As hospitals see more and more service lines shift to the outpatient space, it is crucial to understand your data and associated revenue opportunities. For example, with the Final Hospital Outpatient Prospective Payment System Rule removing total knee arthroplasties from the inpatient only list, this could result in a shift...

How Revenue Integrity Audits Improve CDI Programs

Strong provider documentation is only as good as the codes that are assigned and submitted for payment. Well run CDI programs are successful at ensuring that provider documentation accurately represents the conditions treated and procedures rendered during a patient’s stay; but, they are not as successful at ensuring that coders...

Ready for ICD-11?

According to WHO, ICD-11 will be finalized in 2018. See additional information here: http://www.who.int/classifications/icd/factsheet/en/ and an ICD-11 Beta example here:  ICD 11

Denials Cost Hospitals Millions

According to a recent survey, hospitals and health systems are writing off denials 90% more than six years ago; potentially resulting in $3.5 million dollars in lost revenue for the average 350 bed hospital. The marked increase is driven by a number of factors including increased denials for medical necessity....

Sequencing COPD and Pnemonia – 10/1/17 Update

The more things change, the more they stay the same. According to the latest Coding Clinic release (4th Quarter 2017), coders are once again allowed to sequence either COPD or pneumonia as the principal diagnosis depending on the circumstances of admission. This is a welcome change since it never really...

CKD and Hypertension – Coding Tip

ICD-9 presumed a cause-and-effect relationship between chronic kidney disease (CKD) and hypertension even if another cause for the CKD was noted. ICD-10 only assumes a link between CKD and hypertension when the physician does not document another cause for the CKD (e.g. CKD due to diabetes). Please see cases below...

About Us

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.

Newsletter Sign-Up