How does your healthcare organization identify opportunity/areas of risk? Is a consistent methodology applied? Is data shared among departments? How do you loop in providers/educate? In our experience, healthcare organizations spend a lot of time and resources on the back-end revenue cycle process. With the back-end focus to drop the...
Author Archives: proedge
FY2019 ICD-10-CM/PCS – Official Coding Guidelines and Codeset Update – KEY HIGHLIGHTS
The FY 2019 ICD-10-CM and PCS annual codeset update goes into effect October 1, 2018. See Summary and key highlights below: Summary Codes ICD-10-CM ICD-10-PCS New 279 392 Deleted 51 216 Revised 143 8 ICD-10-CM: MCC/CC Changes Acute respiratory distress syndrome (ARDS) is a MCC – ARDS has finally joined...
Elements of Success for Improve Quality and Shared Savings
In contradiction to Centers for Medicare & Medicaid Services (CMS) data, recent studies show that the Medicare Shared Savings Program (MSSP) has generated $1.84 billion in savings from 2013 – 2015 and reduced Medicare spending by $542 million. How will this data impact the recent CMS proposal to overhaul MSSP...
Accountability through Auditing
Recently, the government determined that a North Carolina hospital failed to comply with Medicare billing requirements for 29% of the cases reviewed in the sample. Using extrapolation, the government is requesting the hospital repay over $700,000 in overpayments. In addition to the repayment, the government included other mitigation strategies that...
ICD-10 DRG Audit Target Area – Cirrhosis with Bleeding Esophageal Varices
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
Define and Expand Your Mobile Strategy
A recent annual survey of over 300 healthcare professionals across the country asked questions about how mobile policies are adopted and enforced and plans for extending mobile technology. Overall, the survey responses indicated that current policy is primarily focused on the use of mobile devices versus defining and expanding mobile...
AHA Coding Clinic 2nd Quarter 2018 – Key Highlights
Coding Clinic 2nd Quarter 2018 (effective with discharges starting June 6th) Below are highlights from the latest release: Diabetes Combination Codes – Not Elsewhere Classified (NEC) As previously noted in Coding Clinic, 2nd Quarter 2016: Page 36, The subterm “with” in the Index should be interpreted as a link between...
ICD-10 DRG Audit Target Area – Chronic Respiratory Failure
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...
Do Frequent Interruptions Impact Physicians? Patients?
Most organizations are acutely aware that clinicians spend increasingly more time at the computer with the evolution of electronic health records and other data capture databases. But, has your organization asked any of the following questions? How much time do your clinicians spend on average using EMR or other databases?...
2018 ICD-10 DRG Audit Target Area – Cerebral Edema
Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s...