“This claim was denied after review and it was determined that the documentation did not support the need for an inpatient level of care.”
NHIC Inc., the Medicare Administrative Contractor (MAC) for jurisdiction 14 (which includes Maine, Massachusetts, New Hampshire, Rhode Island...Read More »
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. This sounds simple, and there had been very little new guidance for...Read More »
Welcome to the 2024/2025 Council term! It’s hard to believe, but this is our sixth Council term and I’m looking forward to getting to know all of you over the next year. This year, we’ve welcomed more leaders into the Council ranks than ever before,...Read More »
The ICD-9-CM guidelines state that it’s unusual for two or more diagnoses to meet the definition of principal diagnosis. However, coders know this isn’t exactly true, as the scenario tends to occur frequently.
Pneumonia and heart failure is a common combination with which patients...Read More »
