Physicians are ethically engaged in keeping patients safe and doing no harm. Unfortunately, medical and surgical care is complicated, especially in patients with high-risk comorbidities; thus, unintended negative results do occur.Read More »
Be aware of payer’s “home cooked” clinical criteria which are often not only outdated, but also ridiculous. Contrary to what the payer may claim, a patient does not regularly have to be at a near death state before having achieved grounds...Read More »
Generally speaking, developing consistent query policies and procedures for both coding and CDI staff helps keep everyone in compliance with coding regulations. Similarly, work with clinicians, CDI specialists, and coders as often as...Read More »
By Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, and Sharme Brodie, RN, CCDS
The goal of the risk-adjustment model applied to Medicare Advantage plans is for Medicare to provide more accurate payments to the plan administrators to compensate for the care provided.Read More »
By Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, and Sharme Brodie, RN, CCDS
There are a number of risk-adjustment models used in healthcare which affect reimbursement as well as quality of care reporting metrics. Each model has its own nuances, but all employ ICD-10-CM diagnosis...Read More »
