Author Archives: Valerie Reich

National Physician Query Survey

Provident recently invited over 25,000 healthcare professionals to participate in a short survey regarding their experience with the process for clinical documentation improvement and coding queries. The objective of the survey was to establish an independent industry baseline after the widespread adoption of EHR systems.  Although the results of the...

Coding Clinic 1st Quarter 2019 – Key Highlights

Below are highlights from Coding Clinic 1st Quarter 2019 – effective with discharges starting March 20th. Human Immunodeficiency Virus and Related Conditions • Code B20, HIV disease, may be reported for cases when AIDS is documented, the patient is treated for any documented HIV-related illness or is described by the...

DRG Audit Target Area – Diabetic Complications

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...

DRG Audit Target Area – Multiple Significant Trauma (MST)

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...

Coding Clinic – 4th Quarter 2018- Key Highlights

Coding Clinic 4th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a...

ICD-10 DRG Audit Target Area – Hypovolemic Shock

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...

Proposed Model to Drive Down Prescription Drug Costs – the potential impact on providers and hospital billing

A recent proposal from the Department of Health and Human Services (HHS) is aimed at reducing prescription drug costs paid under Medicare Part B.  The proposed pricing model would gradually shift Part B payments for delineated outpatient drugs to international prices in late 2019/early 2020, starting with providers in randomly...

AHA Coding Clinic 3rd Quarter 2018 – Key Highlights

Below are highlights from Coding Clinic 3rd Quarter 2018 (effective with discharges starting September 24th). Diabetes with necrotic pressure ulcer, diabetic peripheral vascular disease and neuropathy   If a provider documents an association between diabetes and a pressure ulcer due to gangrene, the principal diagnosis is gangrene The “code first”...

Opportunity in the Data

How does your healthcare organization identify opportunity/areas of risk? Is a consistent methodology applied? Is data shared among departments? How do you loop in providers/educate? In our experience, healthcare organizations spend a lot of time and resources on the back-end revenue cycle process. With the back-end focus to drop the...

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