It started with two courageous coders who knew the query process where they worked at Johns Hopkins Bayview Medical Center, Inc., in Baltimore, wasn't quite right--or compliant.
Specifically, the hospital employed a physician who worked in the billing department to review clinical...Read More »
Healthcare providers in the A/B MAC jurisdiction 1 have a problem—a paid claims error rate that’s nearly twice the national average for Part B claims, according to a recent letter from...Read More »
In 2007, CMS began monitoring claims for hospital-acquired conditions (HAC), which are conditions that occur after the physician writes the inpatient admission order and that could have been reasonably prevented through the application of evidence-based guidelines and best practices. Today,...Read More »
RACs can easily data-mine for noncompliance related to coding for ventilator support, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, independent revenue cycle consultant in Madison, WI. For example, patients whose length of stay is fewer than two days can’t...Read More »
by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS
Because most CMS local and national coverage determinations governing medical necessity and limitations of coverage center around outpatient procedures (e.g., lesion removals, cataract surgeries, and blepharoplasty repairs),...Read More »
While the bulk of discussion regarding how to ethically and responsibly submit queries to physicians revolves around releases from the American Health Information Management Association (AHIMA) releases, don’t discount advice from other potential sources. For example,...Read More »
ACDIS Associate Editorial Director Linnea Archibald sends out “missed connections” emails with questions from Council members on a regular basis. Anyone with experience related to one of the questions was invited to respond and Archibald connected them with the question-asker. In order to share...Read More »
