This article is about spring cleaning your coding and billing! There are a few concerns coming to light that need tidying up. These include the following:
Inconsistent documentation will draw denials if the documentation impacts the reimbursement. Some examples include aspiration pneumonia versus pneumonia, unspecified; chronic diastolic congestive heart failure versus acute-on-chronic diastolic congestive heart failure; and sepsis.
Another issue that may draw a denial is when the documentation does not support the payer’s payment policies. Here are examples:
The Centers for Medicare & Medicaid Services (CMS) has published a fact sheet about the end of the PHE. It is important for your revenue cycle to understand how this change will impact your facility – and not just from a CMS perspective. From a coding perspective, update your facility-specific coding guidelines so that you document the expected changes.
There are proposed changes for MS-DRGs as well as New Technology Add-On Payment (NTAP) items. Make plans to become educated, and communicate those changes.
The Healthcare Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes update on a quarterly basis. It is important to stay on top of the changes to reduce claim rejections or missed revenue. The end of the PHE will impact the chargemaster and revenue integrity as well.
This issue recently came up during a coding review. There was a difference of opinion regarding the coding of Crohn’s disease and its manifestations. According to the coding instruction under K50, an additional code should be assigned to specify the manifestation. The Coding Clinic from the fourth quarter of 2012 also provides the guidance that the manifestation may be separately reported to provide specificity.
Spring always brings with it activity. It may be new codes, new payment rules, or changes in reimbursement methodology. It is important to discuss such changes, develop an action plan, and complete the actions. As healthcare becomes more complicated, communication will be important to be successful.
Programming note: Listen to Laurie Johnson’s live coding report every Tuesday on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer, 10 Eastern.
Denials have been on my mind for the last few weeks – specifically, how do we prevent them? According to the Public Broadcasting Service (PBS),
The PHE has ended and the three-day SNF rule has returned. Following up on my previous article posted in April regarding the return of the
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Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
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This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
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