One of the most vexing challenges that CDI specialists have is how to engage physicians to completely and precisely document their patients’ conditions and treatments in the language required by ICD-10-CM, which is essential to risk adjustment.
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services, according to an Office of Inspector General (OIG) audit report released November 26. Based on the sample, the OIG estimates the hospital may have received at least $3.4 million in overpayments.
Along with its annual updates to the inpatient-only list, the 2020 Outpatient Prospective Payment System (OPPS) final rule finalized a proposal that will give hospitals a grace period to adjust internal policies for procedures recently removed from the inpatient-only list.
The U.S. healthcare system wastes some $760 billion to $935 billion dollars each year, says a recent study published in the Journal of the American Medical Association, and between $27.2 billion and $78.2 billion of that total is the result of failures in care coordination.
In today’s virtual environment, with its focus on flexible schedules, organizing the coding function requires consideration of time zones, team member skills, volume of work, and claim-processing schedules.