The Office of Inspector General (OIG) will be conducting a second round of audits to determine whether acute care hospitals are being inappropriately reimbursed for outpatient services provided to inpatients, according to an update to its...Read More »
Because of the industry’s confusion over sepsis criteria sets, organizations find it difficult to decide which guidelines to follow for their sepsis documentation.
“Many third-party payers have adopted Sepsis-3 criteria, which is not in line with what CMS is doing,” says ...Read More »
Typically, CDI specialists’ work happens before the bill drops, while the patient is in the hospital or immediately following discharge before final coding. Even with the most stringent CDI processes and an exceptionally engaged physician group, we know that...Read More »
It used to come annually. Every October, compliance officers across the country would delve into its pages to determine what the Office of the Inspector General (OIG) planned to investigate for the coming calendar year—and what their facility’s risk level might be.
Almost half of hospitals in the United States will be getting lower payments for Medicare patients due to their readmission history, according to an analysis reported in Kaiser Health News...Read More »
Earlier this summer, CMS resumed Medicare fee-for-service audits which had been suspended starting the end of March because of the COVID-19 public health emergency (PHE).Read More »
Q: Have any other institutions had frequent clinical validation denials regarding acute pulmonary insufficiency following surgery? If so, what clinical indicators and resources do you use to appeal the denials?Read More »
Q: How do you measure productivity for a denials specialist? Do you measure the number of appeals per day, per week, or per month? Are there any other tasks that affect this metric?Read More »
