Developing a strong denial management program may be one of the best ways to minimize the productivity and financial losses anticipated with the transition to ICD-10. By determining a baseline for denials and proactively identifying denial trends, organizations can efficiently resolve issues and reduce costs. An effective denial management program will help organizations to track, trend, resolve, and ultimately prevent denials.
After years of wavering and waffling, ICD-10 was finally set to become a reality on the first of October. The extent to which this new set of codes for medical diagnoses and inpatient hospital procedures will affect you depends largely on how your role is structured, says Stefani Daniels, RN, MSNA, CMAC, ACM, founder and managing partner of Phoenix Medical Management, Inc., in Pompano Beach, Florida.
Compliance with the 2-midnight rule has been tricky for many organizations?and things aren't expected to get easier anytime soon. The 2016 OPPS proposed rule may bring some additional tweaks to the 2-midnight rule (see related story, "Proposed OPPS rule suggests tweaksto 2-midnight rule," in the September issue of CMM), and education and enforcement may change hands from Recovery Auditors to Quality Improvement Organizations.
Today's nurses have more demands on them than ever, with high patient loads and an increasing number of tasks to complete. Often, this increases the likelihood that certain aspects of care may be missed?whether it's needed education on insulin injections that weren't provided before discharge or a patient who develops a pressure ulcer because he or she wasn't turned often enough.
The HIPAA Privacy, Security and Breach Notification Rules require the development and implementation of policies. Covered entities must address all the standards in the rules
