February 13, 2020
By David A. McKenzie, CAE
Differentiating Between Professional and Facility ED Coding
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…
February 6, 2020
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
Underutilization of ICD-10-CM Z Codes for Medicare Beneficiaries
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…
September 20, 2018
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
Emergency Preparedness 101: Going Beyond “Process and Roll”
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…
September 13, 2018
By Chuck Buck
Hurricane Florence: Lessons Learned for HIM Professionals
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…
September 6, 2018
By Holly Louie, RN, BSN, CHBME
CMS’s Proposed E&M Coding Changes – and the Rest of the Story
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…
May 24, 2018
By Ronald Hirsch, MD
New Z Codes Include Code for Millennials
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…
March 8, 2018
By Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainer
Top Audit Finding: Discrepancies in Secondary Diagnosis Assignment on Outpatient and Pro-Fee Claims
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…
October 27, 2017
By Ronald Hirsch, MD
Novitas Guidelines for Malnutrition Reported to be Outdated, not Useful for Physicians
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…
August 10, 2017
By Angela Phillips, PT
IRF 2018 Final Rule: Noteworthy or Calm Before the Storm?
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…
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Allen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAmber Soucy, MSN, RNAndrew B. Wachler, Esq.Andrew B. Wachler, Esq. and Emma E. TrivaxAndrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler and Kaitlin NucciAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTAspen AlbrightBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBenjamin Kartchner MD, CHCQM-PhyAdvBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckClark AnthonyColleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RNDaniel Zirkman, MDDavid A. McKenzie, CAEDavid Jury MD, MSDavid M. Glaser, Esq.Delilah Davis, RN, BSN, CCADenise Coleman, LPNDenise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPEllen Parucka Walker LCSW ACSWErica E. Remer, MD, FACEP, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGlenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAMGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordHolly Louie, RN, BSN, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John K. Hall, MD, JD, MBA, FCLM, FRCPCJulia K. Brodt, PhDJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKathleen K. Borchard, BSN, RN-ACMKathy Seward, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS TrainerLeslie Marsh, RN, BS, MSN, MBALori O’Hara, MA, CCC-SLPMadison AllenMaggie Elehwany, JDMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Anne Hayes Hartman, Esq.Mary Inman, Esq. and Max Voldman, Esq.Matt Lambert, MDMatthew AlbrightMaureen Testoni Esq,Max Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael KennedyMichael Rosen, Esq.Nancy J. Beckley, MB, MBA, CHCNena Scott, MSEd, RHIA, CCS, CCS-P, CCDSPhillip Angello, MDRalph Wuebker, MD, MBARichard “Dick” Beckley, YNS, USN, 1966-1970
