Internal coding audits are an important tool in any hospital’s compliance program. They illuminate potential areas for corrections prior to scrutiny by payers and regulators, which can help reduce payer denials and protect revenue. Additionally, performing regular, ongoing internal auditing can improve clinical documentation and coding initiatives, enhance data integrity, and increase communication across the organization. Not only do they …
Simply mentioning a coding audit sends a shiver up a coder’s spine. The thought of scrutinizing their coding quality, as they strive to balance quality and productivity, can bring dread to even the most seasoned coder. But conducting internal or external coding audits are an important part of ensuring quality and regulatory compliance for hospitals and health systems. Knowing these …
As we discussed last week, over the past decade, there has been a tremendous amount of consolidation in healthcare. For hospital-owned physician practices specifically, we have seen the number rise from 35,700 in July 2012 to 80,000 in January 2018. Over the same period, there was over a 70 percent increase in the number of physicians employed by hospitals …
One of the key trends to emerge from last month’s JP Morgan Healthcare Conference was the shifting mindsets of hospitals. For the last decade, hospitals have had a defensive mindset; acquiring or merging with smaller hospitals and physician practices to outpace their competitors and grow top line revenue. But to receive the full payoff of this consolidation, hospitals need to …
In coding, like most every other area of life, there is not one solution for every organization’s potential problems. Coding is an ever-expanding area of focus for most every healthcare organization, and nearly every health system and the facility has or is making substantial investments in coding staffs and making these departments more robust. There are hurdles and copious challenges …
Preparing For the Upcoming Cancer Registry Changes: Time Is Short, but Support is Available By Susan Mackenzie, MRA For those of us working in the cancer registry profession, you are likely very much aware of the significant changes upon us that will dramatically alter the way we work and how we collect required data for the registry. The upcoming changes …
By Karen Gallagher Grant, RHIA,CHP, COO Planning for an electronic health record (EHR) or technology conversion is slightly different for every hospital or health system, but some clear commonalities must be taken into account. During my career, I have seen some really great models, but also some bad and even ugly approaches. What follows are some of the not so …
One of the more prominent guidelines found in the ICD-10-CM Official Guidelines for Coding and Reporting is Section III. Reporting Additional Diagnoses but it isn’t always applied appropriately. The guideline states: For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or …
Recently, we’ve had a number of conversations with healthcare leaders concerned about their evaluation and management (E/M) coding levels being out of synch with Centers for Medicare and Medicaid Services (CMS) guidelines, and who wanted to review their processes to ensure compliance. Concerns over whether coding departments (if not outsourced) are properly notating the coding level of care provided seems …
Let’s first look at what a Swan-Ganz catheterization is and how the procedure is performed. The Swan-Ganz catheter is synonymous with a pulmonary artery catheterization. It was named in honor of its inventors who were Jeremy Swan and William Ganz from Cedars-Sinai Medical Center in 1970. It is a flow-directed catheter with a balloon tip that is inserted via an …