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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.

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.

5 REASONS WHY CODING & DOCUMENTATION AUDITS ARE MORE IMPORTANT THAN EVER

All health information management (HIM) leaders know that coding quality audits are critical. We can all agree the consequences of substandard coding – lost revenue, increased denials, and greater compliance risk – make the development of a comprehensive coding audit program a priority for healthcare providers of all sizes. Unfortunately, scarce resources and conflicting priorities force many providers to compromise their compliance programs. But now more than ever, audits of coding and documentation quality are critical to the success of healthcare providers.

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.

It’s that time of year again! Time for the ICD-10 CM code updates. The new codes will go into effect with 10/1/17 discharges. There are over 800 changes this year in ICD-10 CM alone! 350+ new codes have been added, 225+ codes revised and 142 codes deleted along with some updates to the Official Coding Guidelines. Quite a few new sub terms were added and changes to Excludes 1 and Excludes 2 notes made so you will want to read these when selecting your code.

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

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

Recently, our CEO, Michael DiMarco, sat down with Lisa Towers, Managing Editor of HFMA, as part of HFMA's Voices of Healthcare Finance podcast series. During this podcast, Michael and Lisa discuss the transition to ICD-10, a forecast for ICD-11, and how the gradual move to value based care impacts the revenue cycle.

Julia Hammerman, Director of Compliance and Education at St. Louis-based himagine solutions, and Terri Eichelmann, Director of Health Information Management at St. Louis-based BJC HealthCare, recently provided Becker's Hospital Review with tips for healthcare organizations and coders navigating the ICD-10 transition.

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