Review coding for HCCs

November 1, 2017
HIM Briefings

Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.

Specificity drives FY 2018 codes and reimbursement ramifications: Three changes to understand

November 8, 2017
HIM Briefings

The focus of FY 2018 code changes is specificity. Payers now expect codes to reflect the exact diagnosis and care given before claims will be reimbursed. Increased granularity in both clinical documentation and coding is critical for revenue cycle success in the year ahead.

Emergency department E/M levels: Do you have any gaps?

November 15, 2017
HIM Briefings

Currently, there are no national guidelines for how facilities should assign evaluation and management (E/M) levels in the emergency department (ED). Under Medicare’s ambulatory payment classification (APC) system, facilities create their own internal guidelines for determining the ED visit level, and each facility must follow its own system to demonstrate compliance.

HIM Briefings HIPAA Q&A

November 22, 2017
HIM Briefings

This month's Q&A answers readers' questions on requests for information, business associate agreements, and the Notice of Privacy Practices.

Engage physicians in ICD-10-CM/CPT coding compliance

November 29, 2017
HIM Briefings

Physicians may be angry at the increased documentation, coding, and billing workflow and compliance activities they must perform to be successful in new reimbursement models. However, to avoid accustations of fraud and upcoding, they must develop their own OIG-recommended compliance plan and be open to rigorous feedback and advice.