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 »
Stepping into any new leadership position, even one you’ve been properly prepared for, can be a challenge. Many CDI leaders find themselves in roles they never imagined they would inhabit and have to learn on the fly. Some started as frontline CDI specialists, reviewing records, and advanced up...Read More »
By Sarah Matacale, RN, BSN, CCS
It is slightly ironic that I’m writing this during this year’s national ACDIS Conference. You see, most people I speak with in the CDI or HIM field get here by choice. They either transitioned through their own efforts or were sought after for their...Read More »
