Resource ICD-10 Monitor Articles

Great article on Acute Pulmonary Insufficiency following Surgery and educating providers on linking respiratory failure to an alternate medical condition.

Acute Pulmonary Insufficiency following Surgery​

Acute Pulmonary Insufficiency following Surgery – MedLearn Publishing

It’s not a valvular problem, but a definitional one. I recently received an email from a clinical documentation integrity (CDI) friend from my previous life as a physician advisor, asking my opinion on acute pulmonary insufficiency. She pointed out that the Association of Clinical Documentation...

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[Lori]

Informative article for health information management (HIM) on data integrity and ambulatory environment.

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Ensuring Data Integrity and Protecting Your Organization’s Bottom Line: Part I​

Ensuring Data Integrity and Protecting Your Organization’s Bottom Line: Part I – MedLearn Publishing

Part I in this two-part series touches on ensuring data integrity and primarily focuses on the ambulatory environment. According to an American Medical Association (AMA) benchmark survey, the number of physicians employed by healthcare systems now exceed those remaining in private practice...

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[Lori]

Ever wonder why E&M documentation still seems to be the same with providers since the E/M 2021 guideline changes? I know I have, and I found a great article with great info on why documentation has not changed from providers since the updated E/M 2021 guidelines have gone into effect.

E&M Documentation Seems to Remain the Same​

E&M Documentation Seems to Remain the Same – MedLearn Publishing

Why are providers not using the new rules to their advantage? This past week, I was sitting in a new client’s office (finally!) in Georgia reviewing ear, nose, and throat (ENT) documentation. I temporarily lost my audit focus, because I started thinking back to how, at the beginning of the new...

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[Lori]

News Alert: CMS Release Proposed Rule for IPPS​

News Alert: CMS Release Proposed Rule for IPPS – MedLearn Publishing

CMS says the proposed rule is intended to enhance medical workforce in rural and underserved communities. Long-awaited and eagerly anticipated the Centers for Medicare & Medicaid Services (CMS) published the proposed rule for inpatient and long-term care facilities. As in two recently proposed...

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[Lori]

Whose Query is it?​

Whose Query is it? – MedLearn Publishing

A reader says that coders, not CDISs, are querying physicians. Across the archipelago of the Internet came a timid yelp to be heard one recent Thursday morning – and it has renewed a tsunami of interest and passion regarding the roles of coders and clinical documentation integrity specialists...

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[Lori]

Medical Decision-Making the only Component for 2021 Office and Ambulatory Services​

Medical Decision-Making the only Component for 2021 Office and Ambulatory Services – MedLearn Publishing

In January 2021, the billing guidelines changed for office and outpatient-based ambulatory services. During my interview with the C-suite occupants for my physician advisor job, I had this epiphany that the hospital gets paid, too. For those of you who do facility billing, you may not be aware...

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[Lori]

Tread Lightly with Sepsis MS-DRGs​

Tread Lightly with Sepsis MS-DRGs – MedLearn Publishing

The patient story is paramount to validating a diagnosis of sepsis. MS-DRGs 872 and 871, Septicemia or Severe Sepsis with MCC and without MCC, respectively, are problematic, from a compliance and reimbursement perspective. Most commercial payers, including Medicare Managed Care organizations...

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[Lori]

AMA/CPT® Errata Clarify some Confusion on Office Visit Documentation Rules​

AMA/CPT® Errata Clarify some Confusion on Office Visit Documentation Rules – MedLearn Publishing

Updates are retroactive to Jan. 1, 2021. The following updates have been made via American Medical Association/Current Procedural Terminology (AMA/CPT®) editorial corrections. These corrections (errata) were posted on March 9 (published on April 1)., however, they are retroactive to Jan. 1...

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[Lori]

Answers to Your Burning Question​

Answers to Your Burning Question – MedLearn Publishing

AMA/CPT® 2021 E&M clarifications are provided for readers and listeners. Ever since the release of the new 2021 Evaluation and Management (E&M) Guidelines for Office and Other Outpatient Services, ICD10University has been conducting numerous provider and staff educational training sessions...

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[Lori]

Proposed IPPS Rule Includes Criteria for Newness​

Proposed IPPS Rule Includes Criteria for Newness – MedLearn Publishing

New substances and devices are cited in technology proposals. The Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2022 fiscal year (FY), which was released on April 27, includes numerous applications for New Technology Add-On Payments (NTAPs). The proposals will be finalized in...

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[Lori]

The Coding Complexities of Mental Health​

The Coding Complexities of Mental Health – MedLearn Publishing

The key is to focus on capturing everything relevant to a patient’s condition. As we observe Mental Health Awareness Month this May, what better time to discuss some common trends and challenges associated with mental health and behavioral health coding? The key to behavioral health coding is to...

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[Lori]

Adopting the Home Environment to the Work Environment​

Adopting the Home Environment to the Work Environment – MedLearn Publishing

Documentation by association. My home office is located in Merritt Island, Florida, and if you’re not familiar with where that is, you’re not the first. It’s actually five miles from Kennedy Space Center, which is about 40 miles southeast of Orlando. I moved into a home office about eight years...

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[Lori]

FY 2022 ICD-10-CM Codes Now Available​

FY 2022 ICD-10-CM Codes Now Available – MedLearn Publishing

New codes are effective Oct. 1, 2021. Highly anticipated, the fiscal year 2022 ICD-10-CM codes have been released by the Centers for Disease Control and Prevention (CDC), although still pending are the 2022 Official Coding and Reporting Guidelines which were not included in the package of new...

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[Lori]

FY 2022 ICD-10-CM Guidelines Are Here​

FY 2022 ICD-10-CM Guidelines Are Here – MedLearn Publishing

The Centers for Disease Control and Prevention (CDC) published the ICD-10-CM Official Coding and Reporting Guidelines for the 2022 fiscal year (FY) on July 12. There are 115 pages in the new release, a decrease of 11 pages from the FY 2021 version. These guidelines become effective with Oct. 1...

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[Lori]

New, Major Regulations Face Providers​

New, Major Regulations Face Providers

Now is the time when major healthcare rules are announced by the federal government. Some major regulations have been announced in the last few weeks. The

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[Lori]

Does Your Organization Have a Blind Spot in the Mid-Revenue Cycle?​

Does Your Organization Have a Blind Spot in the Mid-Revenue Cycle? – MedLearn Publishing

As a former manager of clinical documentation integrity (CDI) and utilization review (UR) at an academic medical center, my focus was on understanding all possible sources of revenue leakage. At that time, the UR staff focused on activities that demonstrated a patient’s medical necessity, as...

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[Lori]

No More Surprises​

No More Surprises – MedLearn Publishing

By Timothy Powell, CPA, CHCP One of the consulting engagements I once turned down was for a group of “mini” hospitals that provided emergency care in rural areas. What drove reimbursement was the fact that they refused to contract with essentially all payors, and they demanded full charges from...

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[Lori]

Are you a HIPAA entity? The “Privacy Law” May not Be What you Think​

Are you a HIPAA entity? The “Privacy Law” May not Be What you Think – MedLearn Publishing

The first thing you should know about HIPAA is that it’s HIPAA, not HIPPA, as is commonly seen. There is only one “P,” and that “P” doesn’t stand for “privacy.” If you have heard the acronym “HIPAA” (referring to the Health Insurance Portability and Accountability Act of 1996) thrown around a...

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[Lori]

Reviewing the 2022 Physician Fee Schedule Proposed Rule​

Reviewing the 2022 Physician Fee Schedule Proposed Rule – MedLearn Publishing

Is split/shared billing really all about time? During my career as an emergency physician, I was the department expert in documentation and billing. In those days, billing meant the professional fee (pro fee), the evaluation and management (E&M) level of service, which is how providers are...

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[WhitneyH_24046]

Thanks Lori!