Auditors have been reviewing medical necessity for inpatient services for years and Recovery Auditors (RA) have recouped millions of dollars in overpayments. Now outpatient providers are beginning to see more and more medical necessity audits, especially in the ED and for evaluation and...Read More »
For many CDI specialists just starting out, finding an experienced mentor can make all the difference. Mentors offer words of wisdom, a helping hand, and sometimes even a much-needed shoulder to cry on. But frequently, mentors gain from the experience as much as they give.
Q:I am concerned about the way we are being taught to write queries; it feels counter to the way I learned at the CDI Boot Camp and the materials I have read via ACDIS. For example, the query lists the appropriate clinical indicators from the record which would support...Read More »
The fight over medical necessity continued last week as the American Hospital Association and its four co-plaintiffs asks courts to “expedite” a lawsuit against U.S. Department of Health and Human Services (HHS) for unfair Medicare practices pertaining to the Recovery Auditor program.
ICD-10-CM/PCS incorporates laterality, acuity, anatomical specificity, and a slew of additional combination and complication codes. Who will submit queries when this information is missing in a medical record? Will coders or CDI specialists take on this role? Perhaps it might be a combination of...Read More »
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are really required to be reported or not. Can a facility simply decide to use on not to use them...Read More »