I am hoping you can provide some insight on compliance and ethical provider education related to hierarchical condition category (HCC) risk adjustment. I’ve reviewed the ACDIS Code of Ethics for the development of provider education, but could...Read More »
I’ve been told that in most cases codes for viral causative organisms, B95-97, will not add a CC or an MCC. However, I thought that identifying a causative organism often does add a CC/MCC. Could you clarify this for me?Read More »
When a patient comes in with two diagnoses and the documentation reflects that either could be the principal diagnosis, do we choose the principal as the diagnosis that is being treated more intensely, or do we choose the higher paying DRG? Is it true that when a patient comes in with two...Read More »
Our system is seeing increasing cases being denied inpatient care with the suggestion that the cases should have been billed as observation. Right now, our coding department handles the coding-based denials, CDI handles clinical validation denials, and care management handles the status denials...Read More »
Currently, when we ask clinical validation queries, we do not take a financial impact into account. We only reconcile as "agreed and documented." Our vendor tells us that some facilities are taking a positive financial impact if they are successful in getting the supporting clinical evidence...Read More »