Proper charge capture processes are essential to compliance regulations. An outdated, non-existent, or poorly thought-out charge capture workflow can be devastating to a hospital and healthcare system’s bottom line. Overcharging can be just as harmful as undercharging for medical services. The key to appropriate charge capture processes has shifted from a solely...

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...

What another crazy year, huh?! In 2021, the OIG continued to publish its work plan with monthly updates including OIG audits and evaluations for the fiscal year and beyond. Although the COVID-19 pandemic continues on, healthcare operations and government oversight entities such as the OIG continue their work. As of the end of November 2021, the OIG had published 12 new...

Protecting the Medicare Trust Fund is an important priority for the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General and thus we have Recovery Audit Contractors or “RACs”. Through the Medicare Modernization Act of 2003, CMS established the Recovery Audit Contractor program with a focus on...

Each year the Office of Inspector General (OIG) publishes their annual work plan for healthcare, which is a highly anticipated publication. The OIG Work Plan sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year. In addition, the OIG updates their workplan on a monthly basis, so their areas of...

The words “Hierarchical Condition Categories” or HCCs can conquer up some anxiety for HIM Coding, and Clinical Documentation Integrity (CDI) professionals, even for Revenue Cycle and Compliance leadership. Add to that, the word “audit” and we now have uneasiness and even fear. Well, it does not need to be this way. Understanding the HCC basics and the coding audit ins and...

COVID-19 Related Coding Audits How Audits in the time of COVID are effecting healthcare institutions. In healthcare, audits, no matter how unpleasant they are, come with the territory. However, with the advent of the COVID-19 outbreak, audits have taken on a whole new level of dreadfulness. Read on to explore subjects related to the combination of Medicare’s medical...

5 Tips to Provide Effective Post-Audit Education You’ve identified high-risk areas based on previous audits or the OIG Work Plan. Or perhaps you decided to audit new service lines or high-dollar as well as high-volume procedures. You’ve selected a random sample of claims. You’ve audited those claims to determine coding and documentation accuracy. Now what? It’s time to...

This article will provide some key points on how you can incorporate the current Office of Inspector General (OIG) items and future items into your organization’s auditing and monitoring functions. Paying attention to what the OIG for Health and Human Services (HHS) plans to audit and monitor during the upcoming year should be a one of the key drivers in developing your...

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,...

A compliance task that each facility should perform to support the Health Information Management (HIM) department is performing coding audits. Coding audits are performed to access the accuracy of the diagnosis and procedures codes assigned to each patient’s chart. The timing of these audits can be performed monthly, quarterly, bi-annually, annually, or as often as the...

  Transcatheter Aortic Valve Replacement (TAVR) is also known as Transcatheter Aortic Valve Implantation (TAVI). Medicare officially refers to this as TAVR/TAVI, but either single acronym is correct. TAVR is a transcatheter surgical procedure in which an aortic valve replacement is performed without removing the damaged native valve. In simple terms, it is similar to...

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,...

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....

March is kidney cancer awareness month. So what is the role of our kidneys? The kidneys are bean shaped organs located on each side of the mid back. The kidneys are retroperitoneal organs that lie behind the peritoneum that lines the abdominal cavity. The main function of the kidneys are to filter the blood and get rid of excess water and waste in the urine. However, did...

The following Latin proverb seems to be particularly relevant in light of ICD-10: “Times change, and we change with them.” By now, ICD-10 has spurred many changes in technology, templates, coding, documentation, and more. However, to be truly successful, organizations must look beyond their HIM internal processes and ask this question: Must the organization’s relationship...

Although CDI programs have typically been implemented in the inpatient setting, many organizations are beginning to turn their attention toward outpatient documentation as well. That’s because many of the same documentation deficiencies occur in both settings. Poor outpatient documentation—particularly in the emergency department (ED) record—can also affect inpatient code...

How to Successfully Navigate Appeals Even with the temporary suspension of RAC reviews, hospitals continue to deal with insurance denials from a multitude of third party payers. Cathie Wilde, CCS Vice President of Coding Responding to these coding denials is time consuming. HIM, revenue cycle and coding professionals are further frustrated when they believe their...