Q: At my institution, we typically do not capture the pleural effusions noted and documented with a congestive heart failure (CHF) exacerbation unless a pleural tap was completed. Coding Clinic states it is acceptable to...Read More »
Editor’s note: This article originally appeared in the Revenue Cycle Advisor. For more information about Hierarchical Condition Categories (HCCs), read ...Read More »
Freedom Health and Optimum Healthcare, two large health insurers based in Florida, are paying $32.5 million to resolve a federal and state investigation into claims they defrauded CMS by submitting risk adjustment scores that improperly inflated their Medicare Advantage reimbursement,...Read More »
The newly released Coding Clinic, Second Quarter, 2017, touches on diagnoses related to neurology such as Parkinson’s disease, encephalopathy, and stroke, as well as questions related to nicotine and drug dependence, among other items, some of which previously lead to discrepancies...Read More »
Q: If the patient is a Medicare beneficiary, why wouldn’t a MS-DRG associated with the newborns and other neonates major diagnostic category (MDC) not be used? Is it because the patient is more than likely 65 (since they are a Medicare beneficiary) and this MS-DRG is for a newborn/...Read More »