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....
Insights
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...
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...
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...
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...
Mitigating Cybersecurity Risks is Essential to Maintaining Trust in the Healthcare System
In the wake of recent ransomware attacks, it is essential for healthcare organizations to assess their security risks and implement procedures, process and other tools to identify and mitigate cybersecurity risks. In a recent Healthcare IT News article, a survey indicated that healthcare organizations account for 34% of all data...
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...