The last 12-18 months has brought the healthcare industry many audit reports from the Office of Inspective General (OIG). These reports are always an important part of every Compliance Program and the related audit and educational activities. Certainly, for Health Information Management (HIM), the OIG audit reports can provide a lens into issues, vulnerabilities, and...

Across the Medicare Advantage (MA) Risk Adjustment (RA) healthcare world, we often hear about “Star Ratings.” With the October MA Star Ratings being released by the Centers for Medicare and Medicaid Services (CMS) a common question is: What are the CMS Star Ratings? CMS publishes the Medicare Part C and Part D Star Ratings each year to measure the quality of health and...

Back in October 2012 (which is fiscal year 2013) the Hospital Readmission Reduction Program or HRRP was started in accordance with Section 1886(q) of the Social Security Act. This regulation set forth the statutory requirements for HRRP, which required the U.S. Department of Health and Human Services (HHS) via the Centers for Medicare and Medicaid Services (CMS) to reduce...

Lung Cancer Awareness is observed in November of each year and reminds us of some important facts.    Lung cancer is the number one cause of death in the United States for men and women. According to the American Cancer Society (ACS) Cancer Facts and Figures 2021, an estimated 235,760 new lung cancer cases will be diagnosed in the United States in 2021 and 131,880...

There are many hints within the tabular index of the new ICD-10-CM codes for FY2022 that may help identify documentation query opportunities. Take a close look at these new codes, see those instructional notes; “Code first,” “Use additional code”, “Code also”, these are some the documentation hints. In addition, some of the new codes have a description or title that...

Summary   As the world of healthcare becomes more complex, healthcare executives are searching for ways to curb costs quickly and substantially while remaining competitive and profitable. Outsourcing is one way to reduce inefficiencies and eliminate redundancy. Let's explore some of the pain points health systems and hospitals face along with the pros and cons of using...

The Centers for Medicare and Medicaid Services (CMS) released a compliance reminder regarding, “Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly” in their October 14th, 2021, Medicare Learning Network (MLN) news. Understanding this particular CMS policy, one needs to review the language: Medicare’s 3-day (or 1-day) payment window...

Dermatology is one of the more complex specialties in medical billing and coding, with a wide range of procedures that can be performed either in the office or in the same day surgery setting. An in-depth understanding of dermatology CPT codes and the appropriate use of modifiers is crucial to ensure accurate coding and reimbursement. Modifier 59 Modifier 59, Distinct...

More changes are coming to the Commission on Cancer (CoC) online portals and how cancer programs access information and resources for accreditation. In a recent news brief the CoC announced that Datalinks, the current online portal, will be replaced by the new ACS Quality Portal, or QPort, as early as late October 2021. Programs in process of resolving a deficiency from a...

On October 1st, 2021, a report from the Office of Inspector General (OIG) was released regarding the Centers for Medicare and Medicaid Services (CMS) coverage violation of insertion or replacement of Neurostimulator Implantation surgeries. CMS had performed an analysis of prior Part B claims data and identified concerns and thus directed a supplemental post-payment...