It’s been eight months since the implementation of ICD-10. It appears the sky has not fallen. Coder productivity as expected has slowed, but is showing signs of improvement. In a recent AHIMA survey conducted in early May approximately 68% of the 156 coding professionals who responded reported that there was...
Author Archives: proedge
Limit Denials through Proactive, Pre-Bill Auditing
The Department of Health and Human Services (“HHS”) issued a proposed rule, published in the Federal Register on July 5th, to change Medicare appeals procedures in an attempt to make the process more streamlined and efficient. Currently, the HHS Office of Medicare Hearings and Appeals (“OMHA”) has a backlog of...
OIG Issues Spring 2016 Semi-Annual Report
Recently the Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its Spring 2016 Semi-Annual Report (“Report”) to Congress for the six-month period ending March 31, 2016. The OIG is mandated to report on a semiannual basis to Congress on the administration of HHS’ programs. The Report summarizes...
Slowing the Revolving Claims Door with Pre-Bill Revenue Integrity Reviews
For the majority of healthcare organizations across the country, the transition to ICD-10 was smooth – cases are being timely coded and dropped and revenue cycle A/R goals are being met. Don’t get too comfortable. Every leader in the revenue cycle should be asking the following questions: How have our...
Reporting Structures of a Compliance Program
While implementing an effective compliance program is not a guarantee of fraud, waste and abuse prevention, it does help mitigate the risk of improper conduct. One key element of an effective and successful compliance program is oversight and defined reporting. Below are tips to consider when implementing or evaluating the...
Coding Clinic Updates: Significant Changes to CHF and Diabetes Coding
Coding Clinic 1st Quarter 2016 Updates The release of Coding Clinic 1st Quarter 2016 (effective with discharges which started on March 18, 2016) brought about two significant changes. Heart Failure The first change is the acceptance of the more contemporary heart failure classification terms that refer to ejection fraction and...
What Accountable Care Organizations Need to Know About the MSSP Final Rule
On June 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its final rule (accessible at, https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-13651.pdf) strengthening incentives for Accountable Care Organizations (ACO) in the Medicare Shared Savings Program (MSSP). According to the CMS Acting Administrator, the changes “will encourage more physicians to improve patient care by...
Clinical Practice Improvement Activities: Become a Top Performer in this MIPS Category
The Medicare Access and CHIP Reauthorization Act (MACRA) streamlines existing quality programs into one Quality Payment Program. Each year participants will choose from 90 clinical practice improvement activities and 300+ quality measures. They will also submit data that will feed 40+ resource use measures and advancing care information measures. Here...
Stop Notification Fatigue! Untether from the EHR Inbox
A study was recently highlighted in JAMA Internal Medicine on the burden of Electronic health record (EHR) inbox notifications. On average, primary care physicians received 77 notifications per work day and specialists received 29 notifications. The study observed 46 primary care physicians and 46 specialists using both Epic and Centricity...
Why Healthcare Organizations Should Conduct a Mock IRO
Independent Review Organization (IRO): Why Your Healthcare Organization Should Conduct a Mock IRO Assessment. While inherent to most Corporate Integrity Agreements (CIA), mock IRO assessments are becoming increasingly popular and proving advantageous to healthcare facilities not under a CIA. Conducting a mock IRO using the Office of Inspector General (OIG)-approved...