by Trey La Charité, MD
Every institution reading this column has likely received its first recovery audit contractor (RAC) denials regarding the documentation and coding of excisional debridement procedures (86.22).
Our hospital is no exception. While we knew that this...Read More »
If you’ve started using your PEPPER to help you identify potential issues at your hospital, good for you! In this final entry, I’m going to suggest you take it a step further—identifying charts that may fail for lack of medical...Read More »
In my previous entry, I talked about the PEPPER process and how it can be used to help identify potential issues of errors in coding, billing, or medical necessity that are specific to each hospital. Now I want to review some target...Read More »
My analytical side is always harassing me to get it more involved in what I do. So I decided to dig into our hospital’s PEPPERs. PEPPER is the Program for Evaluating Payment Patterns Electronic Report, issued quarterly. (Calling it a...Read More »
The Medicare Learning Network released three fact sheets of interest to CDI staff:
The “Hospital Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals” fact sheet (revised October 2010) is now available in downloadable format at
The Hospital Compare website, updated on Dec. 11, contains three new inpatient measures. These include Surgical Care Improvement Project (SCIP) Infection 9 (urinary catheter removed on postoperative day one or two) and two new structural measures: participation in a systematic clinical data...Read More »
When evaluating overall compliance within a CDI department, Lynne Spryszak, RN, CCDS, CPC-A, CDI education director for HCPro, Inc., in Danvers, MA, says that CDI department managers should:
Try not to confine your reviews to a particular payer. Although everyone
The Department of Justice (DOJ) recovered $2.5 billion in healthcare fraud recoveries for fiscal year (FY) 2010—the largest in history—and $3 billion in total civil fraud claims, according to a DOJ press release. Of that...Read More »
