As case managers review the medical record and interview the patient, family, and medical team, they must dig deep and ask hard questions to ensure any unforeseen financial or medical needs are met.
Medical necessity is a term used to describe the need and justification for services a patient will receive, including diagnostic studies or therapeutic treatment. Understand how Medicare defines the term and what requirements must be met.
The CDI educator role is dynamic, evolving to fit the ever-changing landscape of coding and CDI. Consider these tips to help ensure your CDI educators are meeting current needs.
Complete and accurate reporting under the Hospital Inpatient Quality Reporting Program can result in increased reimbursement. Learn how to use coding and CDI teams to improve the collection of correct data under this program.
Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths in the U.S. Tonya Chandler, RHIT, examines ICD-10-CM reporting for fentanyl use, overdose, symptoms, and dependence through several coding scenarios.
Surgical osseointegrated bone prostheses have emerged as a popular alternative to hearing aids. Debbie Jones, CPC, CCA, defines how these devices work and how to report implantation, removal, and replacement of these devices in CPT.
Coders saw extensive code changes and expansion for ICD-10-CM category O35.- in 2023. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG, reviews what coders need to know when reporting fetal conditions affecting the management of the mother.
Elizabeth Hogue, Esq.,explains why it just got a little harder for the federal government to hold healthcare organizations liable under the False Claims Act.
Several proposals in the fiscal year 2024 Inpatient Prospective Payment System (IPPS) proposed rule signal that CMS is serious about a major overhaul of MS-DRG severity levels. Review these and other major proposals to help your organization prepare for the release of the final rule.
