Documentation improvement staff often struggle with principal diagnosis selection. A clear understanding of the definition of principal diagnosis and the factors that play into principal diagnosis selection is extremely important, although often confusing.
The quarterly reports issued by the Program for Evaluating Payment Patterns Electronic Report (PEPPER)contain large amounts of data on how a facility compares to others in the same state, the same jurisdiction (i.e., the same Medicare Administrative Contractor), and nationwide in terms of coding...Read More »
Trying to convince physicians that good documentation has “something in it for them” is a battle that CDI specialists fight each day. But a new CMS initiative that bundles physician and hospital payment into one lump sum could represent a long-term, revolutionary solution to that age-old...Read More »
Out of 88 claims for MS-DRG 246 (percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents with a length of stay less than or equal to two days) reviewed during a recent probe audit, TrailBlazer Health Enterprises, LCC, fully denied 65 of them,...Read More »
Being described as "worse" in a CMS HospitalCompare data file is a dubious distinction.
A recent HospitalCompare list identifies 292 hospitals with 30-day readmission rates that are the highest in the nation in at least one of three disease categories— acute myocardial infarction,...Read More »
