Most of us are familiar with ICD-10-CM through picking codes from a list in our EHRs or perusing a printed code book. Allow me to suggest that unless we understand the coding rules in the ICD-10-CM Official Guidelines, we may mistakenly pick the wrong code, leading to a potential false claim.
The 30-day all cause acute myocardial infarction (AMI) mortality outcome measure has been linked to hospital payments since the inception of the Hospital Value-Based Purchasing Program (HVBP) in fiscal year 2013. In February 2016, CMS announced that 70% of commercial payers have agreed to use this measure as one of the cardiology outcomes linked to payment.
As HIMB’s 30th year comes to a close, we look back on a year of exciting developments and new challenges. Both HIMB and the HIM profession have seen their share of changes over the past 30 years, and this year was no exception.
Today’s HIM professional needs to understand the various programs and the impact that coding and documentation may have on an organization’s performance. By 2018, 50% of Medicare payments will be tied to value-based alternative payment models.
Most healthcare systems already have a proven process in place to monitor revenue integrity and ensure correct reimbursement. Beyond the day-to-day revenue cycle staff involved in revenue integrity, more than 60% of hospital executives believe revenue integrity is essential to their organization’s financial stability and sustainability, according to a survey by Craneware, Inc.
Almost a year after the world of coding was transformed by the implementation of ICD-10-CM/PCS, CMS released the 2017 ICD-10-CM Official Guidelines for Coding and Reporting along with more than 5,000 diagnosis and procedure code changes. The new codes and guidelines went into effect October 1, but not without some controversy. Many of the changes were praised for the increased clarity and level of detail they allow providers to capture. Other changes, though, raised questions and eyebrows and left some wondering what the Cooperating Parties may have intended.
If your hospital resides in one of the 67 metropolitan statistical areas (MSA) required to participate in the Comprehensive Joint Replacement Model (CJR), you will also be required to participate in a new orthopedic payment model called 'SHFFT' (surgical hip and femur fracture treatment) if an August 2 proposed rule is finalized. The impact? The following assigned MS-DRGs will no longer define hospital reimbursement:
Major Joint Replacement or Reattachment of Lower Extremity (MS-DRGs 469, 470)
Hip and Femur Procedures Except Major Joint (MS-DRGs 480, 481, 482)
The Health Information Management Reimagined (HIMR) taskforce is charged with envisioning for the HIM profession in 10 years. The HIMR vision was created to ensure current and future professionals are prepared for the future of HIM in the rapidly changing environment resulting from changes in healthcare, technology, and education. Under the direction of the Council for Excellence in Education (CEE), the taskforce comprises educators from all academic levels (associate, baccalaureate, and graduate) as well as HIM practitioners. The CEE oversight body comprises educators and practitioners who hold a variety of HIM credentials including Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), and other specialty credentials.
