Q: When a patient comes in with two diagnoses and the documentation reflects that either could be the principal diagnosis, do we choose the principal as the diagnosis that is being treated more intensely, or do we choose the higher paying DRG? Is it true that when a patient comes in...Read More »
Findings from a CERT study show that insufficient documentation caused most improper payments for chiropractic services billed to Medicare in 2018, according to the ...Read More »
Q: I’ve heard that the GMLOS is always rounded to the nearest whole number as inpatient claims are paid by day. Based on my understanding of the IPPS, I thought that each inpatient stay is paid by a fixed amount, regardless of the...Read More »
Providence Health & Services wasn’t the only one under fire from Integra Med Analytics. The firm also filed a suit alleging that Baylor Scott & White, a large Texas-based health system, wrongly billed Medicare for more than $61.8 million over seven years through the practice of upcoding...Read More »
Q:I just had a case at work where the patient arrived in respiratory distress, was intubated, and was placed on a vent, treated with IV Solumedrol, HHN, IV antibiotics. The patient came upstairs on the vent. The physician...Read More »
After months of consternation from the CDI community over CC/MCC downgrades included in the fiscal year (FY) 2020 inpatient prospective payment system (IPPS) proposed rule...Read More »