OCR’s 2016 guidance on patient access opened up a debate in the industry and brought questions about fulfilling patient access requests to the foreground.
Documentation and coding based on time requires knowledge about the general principles of E/M documentation, common sets of codes used to bill for E/M services, and E/M services providers.
Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.
Three major types of payer record reviews are conducted every year: The Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Risk Adjustment, and Commercial Risk Adjustment. As the volume of payer and health plan reviews continues to climb, millions of patient records are requested.
CDI review teams can get bogged down and discouraged by routine. A CDI manager should be visible, positive, and combat team complancency and routine fatigue.
Coding experts take a look at changes to ICD-10-PCS, including guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement.
