HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations (ACO), and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper. And that will hit reimbursement hard.
Inpatient coding departments are likely familiar with integrating clinical documentation improvement (CDI) specialists into their processes. Crystal Stalter, CPC, CCS-P, CDIP, looks at how CDI techniques can benefit outpatient settings and what services and codes facilities should target.
Q: If we receive a release of information request from an attorney on behalf of a patient, is it acceptable to respond to the request without seeking verification from the patient on whose behalf the information is being requested?
Copying and pasting information in electronic health records (EHR) increases errors and makes it difficult for clinicians to determine what information is relevant, according to a report from the National Institute of Standards and Technology (NIST) released in January.
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
Probably the most onerous duty physicians have is the preparation of the inpatient discharge summary, especially after a long or complicated hospital stay.
Pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program as well as the Hospital Readmissions Reduction Program. The selection of a principal diagnosis, secondary diagnosis, present on admission (POA) status, and discharge status on each claim determines whether a pneumonia discharge will be included in the measure.
The Office for Civil Rights (OCR) released guidance on patient access fees with little fanfare last year but the guidance, intended to clarify existing OCR regulations, became a flashpoint for controversy. The guidance states that organizations may charge a patient either a flat fee of $6.50 or follow a specific methodology for calculating the cost of making a copy of requested patient records. Although some organizations found their fee schedules out of step with OCR’s guidance, the biggest problem came from an unexpected corner: attorneys.
