CMS released a series of special edition articles applicable to chiropractic services on March 16. Medicare has a very limited coverage benefit for chiropractic services. This article will explain when treatment is covered and how to properly document medical necessity.
This week’s updates include implementation of the award for Jurisdiction A DME MAC workload; April 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.1; and more!
Over-querying is a common concern in CDI. It can influence productivity and workflow. It can cause delays in documentation and coding processes. It can also overwhelm and frustrate physicians, who in turn may be less likely to support or engage with CDI program efforts.
Despite industry pushback and several delays, ICD-10 implementation has, against all odds, gone relatively smoothly for the vast majority of providers, leading CMS to tout its success in a recent blog post from Andy Slavitt, CMS’ acting administrator.
An international task force with expertise in sepsis pathobiology, clinical trials, and epidemiology released updated definitions for sepsis and septic shock this week, which were last revised in 2001.
Clinical documentation improvement (CDI) programs are prevalent in many hospitals and have evolved over the years. In 2014, 66% of 318 hospitals surveyed by AHIMA had a CDI program in place. If all surveyed facilities that planned to implement a CDI program did so, 80% of responding hospitals would have one. These numbers are likely even higher today as CDI programs become ever more relevant.
CDI programs can be a valuable bridge between clinical care and coding at hospitals. By concurrently reviewing clinical documentation in medical records and conferring with and educating providers, CDI teams continually support accurate documentation. When CDI program staff collaborate with providers and coders around improved documentation, the result is more accurate coding, reporting, quality metrics, and reimbursement.
Greater detail in clinical documentation is required since the introduction of ICD-10, making CDI efforts even more relevant. In addition, healthcare is steadily moving toward value-based purchasing and greater scrutiny from regulators and the public. With all of this in mind, it is more important than ever to get documentation and coding right. The daily activities surrounding CDI are crucial to successful outcomes and sustainability of facilities and healthcare systems.
The Hospital Readmissions Reduction Program is a CMS pay-for-performance program that links the amount hospitals are paid to risk-adjusted readmission rates. Measures included in the program are claims based, which simply means that the ICD-10 codes we submit on our claims for payment are also used to assess our performance; our performance then impacts our payment.
Clinical documentation improvement specialists and case managers share a common goal but often aren't on the same page when it comes to improving documentation within the hospital.
