Author Archives: Valerie Reich

Denials Cost Hospitals Millions

According to a recent survey, hospitals and health systems are writing off denials 90% more than six years ago; potentially resulting in $3.5 million dollars in lost revenue for the average 350 bed hospital. The marked increase is driven by a number of factors including increased denials for medical necessity....

Sequencing COPD and Pnemonia – 10/1/17 Update

The more things change, the more they stay the same. According to the latest Coding Clinic release (4th Quarter 2017), coders are once again allowed to sequence either COPD or pneumonia as the principal diagnosis depending on the circumstances of admission. This is a welcome change since it never really...

CKD and Hypertension – Coding Tip

ICD-9 presumed a cause-and-effect relationship between chronic kidney disease (CKD) and hypertension even if another cause for the CKD was noted. ICD-10 only assumes a link between CKD and hypertension when the physician does not document another cause for the CKD (e.g. CKD due to diabetes). Please see cases below...

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...

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...

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...

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