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2018 ICD-10 DRG Audit Target Area – Cerebral Edema

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...

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...

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...

Meaningful Compliance – Defining your Compliance Program

Where does Compliance rank in your organization compared to other functions/priorities? Does the Compliance Officer have the same clout as other executives? Does Compliance play a role in your organization’s strategic and operational decisions? What Compliance expertise is made available/provided to the Board? What specific actions have senior leaders and...

Coding and Documentation Compliance Series

Provident’s Coding and Documentation Compliance Series featured three (3) webinars focused on documentation standards, coding best practices and ways to ensure inpatient hospital based reimbursement aligns with the care being provided. The third webinar in the series, ICD-10 DRG Audit Target Areas includes the following case studies: o Sepsis o...

New Hypertension Codes Released

October 2016 ICD-10 Code Update: New Hypertension Codes Released New hypertension codes for hypertensive urgency (I16.0), hypertensive emergency (I16.1), and hypertensive crisis, unspecified (I16.9) went into effect for discharges starting October 1st. According to Coding Clinic, “The American Academy of Pediatrics requested detailed codes to track patients who present with...

The Cardiac Bundle – What You Need to Know

Just as many hospitals are adjusting to the Comprehensive Care for Joint Replacement (CJR) bundled payment model, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on the next bundled payment model – the cardiac bundle (bypass surgeries and heart attacks). Many in the industry are not...

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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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