RAC denials rose by 24% over the previous quarter, according to the August 22 RACTrac survey results from the American Hospital Association (AHA). Hospitals cite medical necessity denials as the primary target with a majority of...Read More »
CMS recently redesigned its Hospital Compare website to enhance navigation capabilities for users. CDI specialists can use Hospital Compare to review their facility’s status on certain quality measures such as readmissions, infections, and other measures. Using the site during physician...Read More »
A recent Office of the Inspector General report found PacifiCare of Texas received $115 million in CMS overpayments. The OIG reviewed 100 sample cases and found 43 claims with incorrect payments. According to the report,...Read More »
Observation services increased 34% from 2007 to 2009, “from an average of 86.9 observation stay events per 1,000 inpatient admissions per month in 2007 to 116.6 in 2009,” according to a June article in the Journal...Read More »
The proposed rule changes for the Conditions of Participations (CoP) were recently finalized. They include some relief regarding rules for physicians signing, dating, and timing verbal orders within 48 hours of the order being given.
According to the new rule, HHS eliminated the...Read More »
Determining when to code a post-surgical complication as opposed to simply considering it to be an expected outcome after surgery can be a complicated task.
A complication is “a condition that occurred after admission that, because of its presence with a specific principal diagnosis,...Read More »
Over a nine-year period, from 2001 to 2010, physicians increased billing of higher level evaluation and management (E/M) codes in all types of E/M services, according to an Office of the Inspector General (OIG) report released in May...Read More »
