Author Archives: brad

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...

Maximizing Compliant Revenue Capture

A recent analysis revealed that the average 350 bed hospital may not be recognizing a significant amount of revenue – one key factor – denials.  Is your organization assessing denials data and conducting root cause analyses? From the opportunities identified, maximizing revenue in a compliant manner? Are you regularly auditing...

Coding Insight – Postoperative Ileus

Postoperative Ileus Coding Clinic, 1st Quarter 2017: Page 40 Effective with discharges March 13, 2017 Since an ileus can either be obstructive or non-obstructive, Coding Clinic advises that coders cannot assume that a postoperative ileus is obstructive To assign the correct ICD-10 code, documentation must be clear as to whether...

Aspiration Pneumonia and COPD

ICD-10 DRG Target Areas  – Aspiration Pneumonia and COPD 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...

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...

Outpatient and Quality: Where can CDI and Coding make an impact?

Clinical Documentation Improvement (CDI) – The shift to Outpatient and Quality: Where can CDI and Coding make an impact? Over the last several years there has been a steady shift in focus from traditional inpatient clinical documentation improvement (CDI) programs towards outpatient CDI and Quality Improvement programs. This shift is...

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...

mHealth: Security Considerations

According to Mobile Advertising Forecasts 2016 75% of all global internet use in 2017 will be conducted on a mobile device, an increase of 35% in just five years.  By the end of 2018, mobile devices will account for over 1 out of every 4 U.S. e-retail dollars.  The trend is...

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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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