At ACDIS we’re seeing more and more departments expand their medical record reviews to focus on quality measures such as patient safety indicators, hospital acquired conditions, and severity of illness and risk of mortality, among other concerns. The more than 1,200 who trekked out to our...Read More »
Of all the Recovery Auditor denials, hospitals reported appealing about 50% with more than a 50% success rate—it’s 50/50 game that hospitals cannot afford to not play, according to the American Hospital Association’s recent RACTrac...Read More »
In the first half of the 2014 fiscal year, the Office of the Inspector General (OIG) reported more than $3 billion in audit recoveries, nearly $3 billion recovered from investigations, and nearly a million in other non-Department of Health and Human Services (HHS) investigations due to efforts...Read More »
As more facilities face the specter of reimbursement losses related to the Readmission Reduction Program, CDI programs may be asked to take a second look at records to help ensure documentation is adequate to fully support the patient’s diagnoses, says Susan Wallace, MEd, RHIA, CCS, CCDS...Read More »
Q: I am the only CDI specialist in our 150-bed facility. I have held the position for three years, and am the first one to do so helping to build the position from the ground up. Being the only CDI, I am on several committees, responsible for continual physician education, continuing...Read More »
At the close of fiscal year 2013, nearly 5,000 claims denials remained pending review at the Department Appeals Board (DAB) – the last level of administrative review following Administrative Law Judges (ALJ) appeal. The ALJs appeals backlog stood at 460,000, according to the American...Read More »
Physician evaluation and management (E/M) payments cost Medicare $32.3 billion in 2010—about 30% of all Part B payments that year—and of that amount, about $6.7 billion were incorrectly coded or documented, according to an Office of...Read More »
