As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Q: A payer has begun denying authorization for admissions and diverting patients from our hospital to one of our competitors, even when our hospital is closer. Is this a common practice among payers? What language should we add to the contract to discourage it?
Employees need to know what to do and what not to do when it comes to ensuring protected health information (PHI) remains secure. That’s where TeachPrivacy comes in as an excellent resource for quality staff training.
Q: The 2020 ICD-10-CM update added several new codes for legal interventions. What are these codes, and can they be assigned based on nonphysician documentation?
Stephanie, a home care nurse case manager, follows patients with repeated readmissions, stabilizes them in the community, and prevents the readmissions from continuing. But with record-breaking temperatures approaching, Stephanie knows that helping her patients avoid readmission will be more challenging than usual.
