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Beginning October 1, 2019, CMS will use a new case-mix model for Medicare payment, the Patient Driven Payment Model (PDPM), which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.

Everyone remembers the anxiety surrounding the finalized transition to ICD-10 in 2015, And while ICD-10 Monitor notes that the volume of changes is slowing, the 2019 Spine Surgery coding changes are significant. Organizations that don’t act quickly may find themselves facing confusion at best, delays and denials at worst, and a definite impact to revenues.

Tamara Walcott, RHIA, CHPS, Health Information Director, HIPAA Privacy Officer at Nevada State Veterans Home joins himagine Radio to discuss the unique challenges faced by long-term care facilities. Many times, ICD-10 codes make it difficult to “paint the picture” of a long-term care patient’s medical condition. With an aging population, HIM departments in long-term care facilities are going to need more support and resources to help ensure that medical records are accurate. Ms. Walcott also discusses unique HIPAA challenges in a long-term care environment. Things as simple as posting a resident’s picture outside his or her room can become a HIPAA question. Listen in to learn more about her challenges and experiences.

According to AHIMA, a query can be a powerful communication tool used to clarify documentation in the health record and achieve accurate code assignments. Querying has become a common communication and educational tool for clinical documentation improvement (CDI) and coding departments. An effective query process aids the hospital’s compliance with billing/coding rules and serves as an educational tool for providers, CDI professionals, and coding professionals.

The importance of accuracy and compliance in today's coding environment cannot be overstated. High-quality coding is always a priority – but is there a way to make coding impervious to challenges? Unfortunately, the answer is “NO.”  There is no magic wand that can be waived, spell that can be cast, or cape that you can use to ensure your coding program is invincible.  The fact of the matter is that no two medical records are documented in the same manner and most coding clinics can be interpreted differently.

In a previous blog post,  More Than Just HCC's: 6 Best Practices for Outpatient CDI, we discussed the areas that need to be addressed in a comprehensive outpatient clinical documentation improvement (CDI) program. While we recommend going beyond just focusing on Hierarchical Condition Categories (HCC’s), taking a closer look at documentation related to HCC’s is a good place to start. Here are four areas where an HCC-focused CDI program can help you optimize revenue, reduce denials, and improve quality.  

This week's post comes from National Compliance and Quality Audit Manager, Sharon Nichols, BSBEB, RHIT, CCS, CHTS-TR.

The landscape of physician coding changed dramatically in 2015 with the implementation of ICD-10 and MACRA. This coupled with the continued trend of health systems acquiring physican practices has put a greater emphasis on coding of professional services. These factors have contributed to many organizations choosing to integrate phyisican coding into their HIM department.  

This week's post comes from National Compliance and Quality Audit Manager, Sharon Nichols, BSBEB, RHIT, CCS, CHTS-TR.

by Julia Hammerman, Director of Education and Compliance, and Sam Champagnie, Senior Director, HIM Operations

The newness and specificity of ICD-10 ushered in a stronger focus on clinical coding audits. From internal reviews to external coding audits, healthcare organiza­tions nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind. Diagno­sis-related group (DRG) validation audits under ICD-10 have also become more strategic to realize revenue cycle success.