It is important to differentiate between ED professional and ED facility coding, and how levels of service are assigned. EDITOR’S NOTE: Recently, RACmonitor published articles referencing UnitedHealthcare/ Optum’s notice that they were changing the way they process emergency department (ED) claims, beginning April 1, 2020, along with how professional and facility…

CMS report is based on 2016-2017 data. It’s been two years since the American Hospital Association (AHA) shouted from the rooftops that documentation by any interprofessional team would be accepted as validation to use the ICD-10-CM Z codes, as opposed to only documentation by physicians. In the social determinants of…

Accounting for socioeconomic factors is critical to the sustainability of healthcare. Editor’s Note: This article was written as Hurricane Florence was heading directly for the United States’ East Coast. Stores from the Georgia to Delaware have barren shelves where staples, as water and toilet paper are usually stocked. Nature and…

HIM professionals are offered advice for hurricane preparedness. EDITOR’S NOTE: At press time, Hurricane Florence, described as an “extremely dangerous” Category 4 hurricane, was headed for the southern North Carolina coast. In a written statement to RACmonitor, Atrium Health, formerly Carolinas Healthcare System, said that its teams “remain focused on…

The proposed documentation changes will require retraining an entire industry. EDITOR’S NOTE: The public comment period for the 2019 proposed MPFS closes Monday, Sept. 10, 2018. The 2019 proposed Medicare Physician Fee Schedule has clearly articulated the Centers for Medicare & Medicaid (CMS) goal of “patients over paperwork.” I think…

New Z codes also aimed at reducing hospital readmissions. The one thing that medicine does not have enough of is abbreviations. So allow me to introduce the RACmonitor audience to another one: SDoH. I am sure many of you are aware of the social determinants of health (SdoH), but for…

There is no need to worry about coding for HCCs or risk adjustment, writes the author. Just follow the coding guidelines. Confusion abounds regarding the application of Section IV ICD-10-CM Coding Guidelines. And while hospital outpatient coders may be more programmed to code additional diagnoses, physician pro-fee coders may just…

Release of outdate guidelines raises fears that other MACs might adopt them to audit providers. The use of outdated definitions of malnutrition by a Medicare Administrative Contractor (MAC) is raising concerns that other MACs may adopt the same flawed practice. The universally accepted definitions, known as the American Society for…

The Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule for the 2018 fiscal year was published Aug. 3, 2017 without any major changes in policy and with the expected minimal updates to payment. Some key provisions of the Final Rule include the following. Specifically, it: Updates the federal prospective…