Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
In recent years, the U.S. healthcare system has begun a shift from a volume-based to a value-based system, causing the role of many case managers to evolve. So what does this role look like, and how can your organization get there?
Q: Can you explain where in the clinical documentation it would be acceptable to report from for Hierarchical Condition Category (HCC) purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?
