There has been much discussion based on what Recovery Audit Contractors (RAC) and other state and federal regulatory bodies are doing or what their next move will be (though does anybody really know?!?).
We’ve all heard the stories of denials of well...Read More »
A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the recovery audit contractors (RACs). Of particular concern, according to William E. Haik, MD, FCCP, a pulmonologist and director of DRG Review, Inc., in Fort...Read More »
The RACs have ramped up medical necessity reviews. Determining the medical necessity of an inpatient admission can be a complex process so we have to look at several different places for CMS guidance.
According to the Medicare Benefit Policy Manual, Chapter 1, § 10, an “inpatient...Read More »
CMS plans limited changes to CCs in fiscal year (FY) 2012, but proposes new MS-DRGs for excisional debridement as well as an additional hospital-acquired condition (HAC). These and other changes are part of the inpatient prospective payment system (IPPS) proposed rule posted April 19. The...Read More »
Starting October 2012, Medicare will begin paying hospitals for quality measures, according to a CMS fact sheet released April 29. The new Hospital Value-Based Purchasing (VBP) program adopts performance measures under two “domains”:
Q: Are there any coding guidelines/definitions regarding code 518.5 (Pulmonary insufficiency following trauma and surgery) vs. the use of 518.81 (Acute respiratory failure postop)? If a physician documents postop respiratory failure, which code should we report? I looked in Coding Clinic...Read More »
The overarching goal of a documentation improvement program is not to improve reimbursement for the hospital, but to effect a positive change in the behavior of those who document in the medical record. This change...Read More »
CMS detailed seven shortcomings, including old and inadequate policies and procedures, in its 2009 audits of healthcare organizations to determine compliance with the HIPAA Security Rule. CMS detailed the findings in its ...Read More »
