My experience in ICD-10-CM documentation and coding integrity is that many physicians know in their heads what is wrong with their patients; however, they have not been taught to “think with ink” in describing their patients' illness in the EHR using ICD-10-CM’s language to ensure proper coding.
Access to protected health information (PHI) is one of the most important rights individuals and their personal representatives have under the privacy regulations, but this right is not absolute.
Maybe it’s the doctor who screams at you or publicly berates you when you come to him with a question that interrupts his busy day. The colleague who throws things when the job gets too stressful.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
This week’s Medicare updates include notification of a new interest rate for Medicare Overpayments and Underpayments, revisions to the Medicare Claims Processing Manual regarding payment of services furnished by qualified nonphysician anesthetists, a fact sheet for hospitals on the 2018 Medicare EHR Incentive Program payment adjustment, and more!