Author Archives: Valerie Reich

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...

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