News

MACRA Data Blocking Update

As healthcare organizations determine how to report under MIPS, consider recent guidance from the Centers for Medicare & Medicaid Services (“CMS”) on the data blocking provision. Eligible clinicians must show they are meeting the information blocking requirements by attesting to three statements about how they implement and use certified EHR...

2018 OPPS Key Highlights

How does the recently issued 2018 Medicare Physician Fee Schedule impact your organization? Get to know the following key provisions: Payment Rate Changes. Off-Campus Provider-Based Departments: Except for dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under OPPS on or after November 2, 2015, or...

AHA Coding Clinic 4th Quarter 2017 – Key Highlights

Coding Clinic 4th Quarter 2017 (effective with discharges starting October 1st) included the FY 2018 ICD-10-CM/PCS codeset updates (see article here), Official Guideline revisions, and question and answer coding guidance. Below are the key highlights: Severe Sepsis Coding Guideline Change  Physicians must document the relationship between sepsis and organ dysfunction...

Assessing the Discharge Planning Process – Essential for Compliance and Reimbursement

Does your facility accept Medicare and Medicaid? For the majority of hospitals across the country, the answer is “yes”, requiring compliance with Medicare Conditions of Participation (CoP) for discharge planning. Discharge planning is not a new concept to hospitals, but recently, more detailed guidance combined with financial penalties associated with...

2018 ICD-10-CM and ICD-10-PCS Codeset Update – Key Highlights

The FY 2018 ICD-10-CM and PCS annual codeset update goes into effect October 1, 2017. Below are the key changes: Summary of Changes Codes ICD-10-CM ICD-10-PCS New 360 3,562 Revised 250+ 1,821 Deleted 142 646 ICD-10-CM New Acute Myocardial Infarction Codes I21.9 MCC Acute myocardial infarction, unspecified I21.A MCC Other...

Fraud Detection – CMS Changes Direction

Recently, the Centers for Medicare & Medicaid Services (“CMS”) released a process change in its fraud detection program shifting focus to providers who have the highest claim error rates or billing practices that vary significantly from their peers. In the past, CMS contractors selected providers using a more random approach...

Coding Clinic 3rd Quarter Highlights

The release of Coding Clinic 3rd Quarter 2017 (effective with discharges which started on July 27, 2017) brought about the following key changes: ICD-10-CM – Diagnosis Changes Emaciation If the provider documents emaciated or emaciation, coders are instructed to assign code R64 – Cachexia For a coder to assign E43...

2018 Proposed Rule for MACRA’s Quality Payment Program

On June 20, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the CY 2018 Updates to the Quality Payment Program.  As a refresher, the Quality Payment Program has two pathways for clinicians – (1) Merit-based Incentive Payment System (MIPS) or (2) Advanced Alternative Payment...

Maximize Compliance and Revenue with Provident

Complimentary Review of 30 Inpatient Records Provident understands the financial pressure hospital organizations across the country are feeling due to increased regulation and shifts in reimbursement methodologies. Every dollar is crucial.  Provident’s Revenue Integrity Audit methodology can help by maximizing revenue capture in a compliant manner.  With years of proven results...

CMS Seeks Input for Consideration in Future Rulemaking

Request for Information On April 14, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2018 Inpatient Prospective Payment System (“IPPS”) proposed rule including a Request for Information (“RFI”).  The overarching message from CMS is to seek comments to the proposed rule and through the RFI that will...

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