For many years now, healthcare reimbursement has been based not only on whether care was provided but on how well that care was provided and the patient’s outcome following that care.
While the premise for quality programs is largely the same across the board—measure the quality of care...Read More »
According to this year’s CDI Week Industry Survey, only 10.38% of respondents (most of whom work in inpatient settings) don’t review for quality measures, continuing a year-over-year decline. For most folks on the inpatient side of the CDI world, reviewing for quality isn’t an expansion area...Read More »
The fiscal year 2020 Inpatient Prospective Payment System (IPPS) proposed rule threw gas on the population health fire when it proposed giving social determinants of health (SDOH) codes more weight as complications/comorbid conditions (CC). The final rule threw some water on the pyre, however,...Read More »
The ICD-10 Coordination and Maintenance (C&M) Committee met on September 10–11, 2019 to discuss code proposals for implementation on October 1, 2020, for fiscal year 2021. Several members of the ACDIS CDI Regulatory Committee listened to or...Read More »
by Irina Zusman, RHIA, CCS, CCDS
Both ccommercial and public payers now deny about one in every 10 submitted claims, costing health systems up to 2% of net patient revenue, according to a March 2019 article in Modern Healthcare. As the cost of healthcare continues to skyrocket,...Read More »
Every year, organizations receive more denials, and payers’ tactics are shifting based on coding rules, clinical criteria, and their own whims.
As a result, many CDI teams find themselves involved with the denials management and appeals process—whether that means weighing in on a case-by-...Read More »
By Candace Blankenship, BSN, RN, CCDS
The role of the CDI specialist is in constant flux. When I started out as a CDI specialist, my hospital wanted me to focus on reimbursement. Having one focus gave me a clear path and little conflict when I was educating and querying providers...Read More »
On February 23, 2016, the Journal of the American Medical Association published new clinical definitions for sepsis and septic shock, dubbed “Sepsis-3.” In the three years since then, a host of analyses and conflicting documentation and coding requirements have caused not only consternation but...Read More »