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.
We’ve already written over the past year about expected changes to the Cancer Registry– and how extensive they are likely to be. No doubt – this is a big deal. Remember the shift from ICD-9 to ICD-10? The Cancer Registry changes are a lot like that – but with an even more profound impact on hospital workload and productivity.
Topics: Cancer Registry
Corrine Byrd, HIM Clinical Documentation Manager at MD Anderson Cancer Center, manages a team made up of nurses, professional nurses, and professional health information management (HIM) coders, a good mix for a clinical documentation improvement (CDI) team since they are able to learn from each other’s different backgrounds. Ms. Byrd shares her insights on running an effective CDI program, including “knowing your institution” to better bridge the gaps in documentation that may be unique to your facility’s specialties, offering provider education that helps physicians present a clear picture of the patient in diagnostic terms that can be coded, and ensuring clear communication between the CDI specialists and the providers.
In a blog that I wrote earlier this year, I talked about the importance of being prepared for expected changes in the cancer registry. Well, we are well past the half way point of 2018 and are still navigating the changes. In fact, after attending the Florida Cancer Registry Association Meeting, I learned of some changes Cancer Registrars should be aware of. So, I thought it might be high time to provide an update!
Here’s what I learned at the meeting:
- The STORE Manual (Standards for Oncology Registry Entry) was released on August 15, 2018 and is now available and ready to use. You can access the STORE Manual by clicking here.
- Some cancer registry software vendors might not have their 2018 versions released until October.
- The Solid Tumor Manual still has some chapters in draft format.
Topics: Cancer Registry
Debi Primeau, RHIA, FAHIMA, President of Primeau Consulting Group spoke with himagine about learning from “online Goliaths,” such as Disney and Princess Cruises, and applying their best practices to healthcare. “What we need to do in healthcare is to be able to take the data and be able to make it usable. And to be able to move forward … to analyze the data and help people improve their health.” In this podcast, Ms. Primeau provides a blueprint for implementing information governance (IG) practices that can improve financial performance as well as patient outcomes.
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.
Audits Offer Fix for Poor Coding Compliance, Lagging Reimbursement
THE EVER-INCREASING complexity of healthcare is driving the need for coding quality and compliance programs. Given the transition to ICD-10, advancements in treatments and procedures, a move to quality reporting, and evolving regulations with potentially lofty penalties, the lost reimbursement at stake as the result of poor coding is driving more providers to intensify their coding audit programs.
The trend among large providers is a wave of both random and targeted audits at varying stages of the revenue cycle—from pre-bill to post-bill analysis of key issues ranging from denials to specifics such as transfer DRGs.
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.
There is no doubt, attendees of last week’s ACDIS 2018 conference will be speaking about it for months to come. The conference was comprised of over 90 speakers including physicians, registered nurses, health information management (HIM) administrators, certified clinical documentation specialists (CDIS) and certified documentation improvement practitioners (CDMP) to name a few. The tracks included something for everyone: Clinical & Coding, Management & Leadership, Quality & Regulatory, Expansion & Innovation, Outpatient and Pediatric. Needless to say, the educational opportunities were vast and it would be nearly impossible to share them all.