Those who regularly attend the annual AHIMA Convention and Exhibit no doubt have seen the exceptional quilt created each year by AHIMA member Katy Sheehy, MPA, RHIA, and sponsored by the Dames of Distinction to be bid at auction. The quilt is auctioned in support of the Linda Culp Memorial Scholarship fund, which was established in memory of the late Linda Culp, a former HIM professional, hospital chief executive officer, and AHIMA member. If you have seen the quilt, you have probably asked yourself, "Who are these people?"
The healthcare industry is focused on the triple aim: reducing healthcare costs, improving patient experience, and improving the health outcomes of populations. Healthcare organizations will no longer be paid based on the volume of services provided but rather on the value of care delivery.
Q: Our providers are reluctant to document a correlation between symptoms and a detailed diagnosis. Do you have any good ways to get them to do this? For example, our providers document "diabetes" but they often don't include additional details that should be there (e.g., gestational diabetes or type II diabetes mellitus in pregnancy).
CMS' coding modifiers are not always used to report clinical components of a service. Sometimes they can be used in order to provide information about how a service relates to Medicare coverage policies.
As healthcare providers increasingly accept financial risk associated with patient management due to the transition from fee-for-service to risk-/value-based reimbursement, the traditional model of healthcare reimbursement has been flipped upside down.
