Q: I am with a CDI program that is starting to explore the severity of illness/risk of mortality (SOI/ROM). I personally have been reviewing for SOI/ROM for quite a while. I usually designate the impact (MCC/CC/SOI/ROM) after the billing is done and see if what I queried for...Read More »
Recovery Auditor medical record requests and automated and complex denials all fell slightly in the first quarter of 2016, as did the average number of medical record requests per hospital, which decreased slightly since the fourth quarter of 2015, according to the latest RACTrac report...Read More »
CMS issued a final rule last week to revamp the way it pays for tests under the Clinical Laboratory Fee Schedule (CLFS). Now starting January 1, 2018, CMS will base CLFS payments on the weighted median amount paid by private payers for the same services. Providers are hopeful that these new...Read More »
The MS-DRG 884, organic disturbances and mental retardation, received a request for a title change, in the 2017 IPPS proposed rule released by CMS, to organic disturbances and intellectual disability to...Read More »
The Government Accountability Office (GAO) says the Department of Health and Human Services (HHS) should take steps to reduce the number of Medicare appeals and strengthen oversight of the appeals process, according to a report released by the GAO...Read More »
Auditors target multiple conditions which for clinical validation denials (CVD). Personally, I found acute kidney injury (AKI) and malnutrition the most commonly defensible targets. On the other hand, I often agreed with auditors on their CVDs...Read More »