OPPS Proposed Updates Released July 8, 2013

Just in case you haven’t had a chance to get into the Federal Register and review the proposed changes; here are a couple of the highlights. The Centers for Medicare & Medicaid Services (CMS) are proposing a collapse of hospital outpatient clinic and ED visit codes instead of recognizing the current five levels of clinic … [Read More]

Is it Medically Necessary?

If so, can you prove it? Documentation is the key to payment for services rendered. We have heard it time and time again. As coders we have to be cautious and precise with our coding decisions in order to stay compliant and assign codes to the highest level of specificity gleaned from the documentation. This … [Read More]

Half Way Through 2013

As we approach the midpoint of 2013 and attempt to carve out time for all that is required of us, both personally and professionally, here are a few thoughts:  In sixteen months the most significant change in revenue management will occur with the conversion to ICD-10.  Although we expect that most coding teams have a … [Read More]

Third Quarter CDM Updates – Effective July 1, 2013

It’s that time again…  Updates to the Charge Description Master (CDM) for the third quarter are already here.  How time flies! To summarize, there have been new APCs assigned, deletions, revisions to descriptions and status indicator changes. It is crucial that your CDM is updated to reflect the new information and codes available to ensure … [Read More]

Maximizing Hospital Reimbursement through ERISA Appeals

Healthcare has a language all its own.  It is an alphabet soup of acronyms and alpha-numeric nomenclature.  Enter E-R-I-S-A. Introduced into law in 1974, the Employee Retirement Income Security Act (ERISA) was originally put in place as a protection in private industry for employees with employer-sponsored pension plans.  The law addressed minimum standards related to … [Read More]

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