All short-term acute care facilities earn reimbursement from Medicare according to the inpatient prospective payment system (IPPS), right? And all outpatient facilities obtain reimbursement according to the rules in the outpatient prospective payment system (OPPS), correct?
Because of payers’ propensity for denials, facilities need to have a process in place for managing denials’ root causes on the front end and appealing them on the back end. This, however, can involve a lot of hard work and headaches.
By Cheryl Manchenton, RN, BSN
From a bird’s–eye view, your CDI program may be a well-oiled machine. CDI specialists pose queries, physicians respond, and coders assign the most accurate and specific codes. But, what happens as your organization continues its journey from volume-...Read More »
A patient comes into the hospital, so sick that there’s likely no coming back. The physicians do everything they can, but the patient expires. Anyone working in a hospital setting knows this scenario all too well.
But, look more closely at the documentation for that patient. In many cases...Read More »
by James S. Kennedy, MD, CCS, CDIP
Over the years there’s been a tsunami of denials from payers, Recovery Audit Contractors (RAC), and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can...Read More »
by Linnea Archibald
It’s hard to believe my ACDIS journey only began six months ago. As anyone new to CDI will tell you, the mountain of information can be overwhelming. Lucky for me, I’ve never been tasked with reviewing a record and querying. Though I’ve learned a lot in the...Read More »
by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
In the past, I have advised CDI professionals against promoting the monetary benefits of CDI adoption. If the medical staff thinks the program’s purpose is hospital revenue, they will likely rebel. Working in an academic institution, I...Read More »
“When I first started getting interested in the topic of CDI, […] I asked my more senior colleagues and got blank stares,” says Joseph A. Cristiano, MD, an assistant professor of internal medicine at Wake Forest Baptist Health in Winston-Salem, North Carolina. Without the...Read More »
