When CMS introduced Hierarchical Condition Categories (HCC) with risk-adjusted scores, Ochsner Health System began efforts to educate providers and improve documentation across its many facilities.
There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Hospitals may find that certain coverage requirements for therapeutic and diagnostic service are more difficult to meet than others, especially in off-campus provider-based departments.
Kidney disease is a challenging component to inpatient and outpatient care, incurring significant costs and negative outcomes. CMS and other agencies that measure our quality and cost efficiency use ICD-10-CM codes based on provider documentation and billing to ascertain that a patient has a designated kidney anatomic or functional illness in their risk-adjustment methodologies.
When it comes to dealing with Medicare Recovery Auditors (RACs), there is never a dull moment for HIM professionals. Any shift in the RAC program quickly emerges as front-page news for HIM leaders.
