Consulting

CMS published a valuable and (surprisingly) easy to read fact sheet relevant to anyone in the mid-revenue cycle.  Link to “Complying with Medical Record Documentation Requirements” below, along with a handy ACDIS recap. The fact sheet lays out four common sources of denial related to insufficient documentation. CDI, coding, and compliance professionals, take note. The…

By Jason Jobes, SVP Solutions Technology is a must for ensuring complete and accurate depiction of patient complexity. An emerging tool in the arsenal of many organizations are electronic prompts to the provider at the immediate point of care. Unfortunately, the CDI/coding industry has a notable lack of regulatory guidance on compliant use of point…

By Joanne Wilson, RN, ADN, CCDS, Senior Director, Solutions We have a new ICD-10-CM code to bill sepsis aftercare. Effective October 1, 2024, coders can report Z51.A: Encounter for Sepsis Aftercare. Z51.A was long in the making, needed to fill a gap in post-sepsis care. Sepsis is nasty and can result in long-term health complications.…

By Joanne Wilson, RN, ADN, CCDS For this month’s CDI suggestion I wanted to offer up a clinical scenario for your consideration. I do encourage you to read it, and think about what you’d do. My suggestion follows. A patient is scheduled for an appointment with their provider in 96 hours. As a prospective OP…

Can the work of a CDI specialist or risk adjustment coder impact HEDIS measures?   It’s a question growing in importance, as reimbursement is tied to quality outcomes, and transparency and star ratings allow patients to shop for providers and health plans.   Some believe HEDIS measures are impacted/satisfied only through the provision of clinical…

Why risk adjustment coders are more valuable than ever   By Crystal May, CCS, CPC, CDEO, CPMA, CRC, AAPC Approved Instructor, Senior Risk Adjustment Consultant, Norwood   If you’re of a certain age, the title of this article probably conjured up the image of a popular male actor sliding across a wooden floor in a…

Postop respiratory failure: The never-ending query By Donielle Bailey, RHIA, Norwood Senior Auditor We have all experienced the frustration of coding a complex or detailed elective operative report only to become ensnared in a postop progress note respiratory battle. Physicians provide their clinical assessment of the patient’s postop respiratory condition with documentation that includes, “intubated…