Conducting pre-billing audits can be challenging, but when done correctly, it can save organizations from spending time recoding and rebilling claims that payers deny. These audits can be conducted on the front end, in both inpatient and outpatient settings, once records have been coded.
EDs have a lot to handle. One in every three Americans will visit an ED each year, and among those are a number of populations that bring special challenges.
In November 2014, CMS put its certification requirement under the 2-midnight rule to bed, finally conceding that the rule was creating more problems than it solved. While many frustrated case managers celebrated this development, they still aren't completely off the hook. CMS replaced the global certification requirement with two more-specific certification requirements that went into place on January 1, and case managers need to be aware of them.
Condition codes can cause considerable confusion for case managers. Coders use them to support payment for out-of-the-ordinary situations?for example, an inpatient being changed to outpatient status.
Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to accommodate the new code set was a top concern for the healthcare industry.
Q: I work in long-term care, and I am familiar with the language in HIPAA regulations regarding requests for electronic copies of medical records for a reasonable fee according to community standards. However, my company does not maintain its medical records in electronic form, nor do we presently have the capability of converting our paper records into electronic format.
