The ICD-10 partial code freeze is over and effective October 1, 2016 there will be many changes to the ICD-10 code set. Recently both the Centers for Disease Control and Prevention (“CDC”) and Centers for Medicare & Medicaid Services (“CMS”) released the 2017 ICD-10-CM and ICD-10-PCS codes. Below is the...
The 60 Day Overpayment Rule
Reporting and Returning Self-Identified Overpayments: the 60 Day Overpayment Rule Overpayments occur, even in the most efficient and complaint provider settings. Overpayments may be isolated (e.g., adding a modifier to a claim) or involve hundreds of claims (e.g., inappropriately billing observational services). Overpayments may occur as a result of a...
ICD-10 flexibilities updated
CMS/AMA joint announcement and guidance regarding ICD-10 flexibilities updated Last year, the Centers for Medicare & Medicaid Services (“CMS”) and the American Medical Association made a joint announcement regarding guidance on ICD-10 flexibility. The ICD-10 flexibility allowed Medicare Part B providers to bill ICD-10 from the right family but not...
Improve your CDI query process with mobile technology
Why use mobile technology to improve your CDI query process? DocEdge™ Communicator mobile and web-based application: Expedites physician responses securely Drives query quality Reduces notification fatigue See the infographic below for more information.
2016 Coding Webinar Series
Announcing Provident’s 2016 Coding Webinar Series Provident is pleased to announce the 2016 Hospital Coding and Documentation Compliance webinar series. Provident’s Coding and Documentation Compliance Series will feature three (3) webinars focused on documentation standards, coding best practices and ways to ensure inpatient hospital based reimbursement aligns with the care...
Enterprise Risk Management – Essential Elements for a Successful Program
From our experience assessing and implementing Enterprise Risk Management (ERM) programs across the country, Provident has identified seven key elements for success: Phased Approach – ERM programs involve active engagement from leadership as well as on the ground operational teams. Enhance or develop your program in phases, allowing for organizational...
Mitigating Increasing Readmissions to Avoid Reduced Reimbursement
CMS released the results for year five of the Hospital Readmissions Reduction Program. Here is what you need to know: What was covered? CMS examined hospitals’ 30-day readmission rates for seven conditions: Heart attacks Heart failure Pneumonia Chronic lung disease Hip and knee replacements Coronary artery bypass graft surgery What...
Clinical Documentation Improvement in 2016
Clinical Documentation Improvement in 2016 – The New Normal Over the past several years, Clinical Documentation Improvement (CDI) Programs have proliferated. In fact, 81% of hospitals have reported having a CDI Program according to a 2015 study by the Advisory Board. The emphasis on documentation has been driven by internal...
2017 IPPS Rule Released
The Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS Rule this week (accessible at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-18476.pdf). Key things to be aware of in the 2,434 pages: Two-midnight rule inpatient pay cuts were not adopted Financial benefits and penalties related to the reporting of quality data and meaningful...
The Cardiac Bundle – What You Need to Know
Just as many hospitals are adjusting to the Comprehensive Care for Joint Replacement (CJR) bundled payment model, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on the next bundled payment model – the cardiac bundle (bypass surgeries and heart attacks). Many in the industry are not...