Insights

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...

Medicare Cost Report: What is it?

All Medicare certified institutional providers are required file an annual cost report to their respective Medicare Administrative Contract (“MAC”). But what is a Medicare cost report and what is the process for submitting and finalizing one? The Medicare cost report is comprised of a series of worksheets and schedules that...

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...

Guidance on How It Determines the Effectiveness of a Compliance Program

The Department of Justice Issues Guidance on How It Determines the Effectiveness of a Compliance Program Recently, the Department of Justice’s (“DOJ”) Fraud Section released guidance entitled “Evaluation of Corporate Compliance Programs,” (“Compliance Memorandum”), which highlights how federal prosecutors investigate the adequacy of an organization’s compliance program during a criminal investigation....

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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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