Rayellen Kishbach's blog

Keeping up with MS-DRG Revisions

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CMS has issued two errata and correction notices for how MS-DRG logic functions in FY2017. These changes may impact payment. This article highlights a few examples.

It is important to note that CMS published v34 r2 in time for implementation on 10/1/2016, but the v34 r3 was released after claims for FY2017 had begun, so improper payments may have occurred.

Supporting Compliance in the New World of Remote and Outsourced Coding & Billing.

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According to a recent HIM Benchmark Report, HIM department managers equally ranked Coder Productivity, Quality, and Managing Financial Metrics as their biggest challenges, while that same report noted that close to 60% of HIM professionals outsource a portion of their coding needs. Even without direct outsourcing, we notice an increase in the opportunity to do coding and billing work remotely.

Understanding MS-DRG Grouping under ICD-10

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Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools.

How we can help you "Ramp Up" your ICD-10 Operations

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On July 31, 2014, CMS announced that the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. According to CMS:

"This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015."

How do Medical Review professionals keep up?

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The ever-increasing pace of healthcare benefit and coverage policy change makes it harder than ever for medical review professionals to make quick, completely informed policy and reimbursement decisions. Without the right information and tools, your organization’s exposure to risk increases. This risk is multiplied when you have to monitor and comply with updates across multiple states.

Understand Local and National Coverage with MAC Coverage Articles

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We know understanding Medicare coverage is a challenge, and we've just made this challenge easier by upgrading all of our health care products to include Medicare Administrative Contractor (MAC) Local Coverage Articles. These articles can provide a deeper explanation of the MAC Local Coverage Determination (LCD) logic, or explain special topics like non-covered services, self-administered drug lists, coding rules for National Coverage Determinations (NCDs) and more.

Demystify Inpatient Reimbursement with Simple Tools

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Understanding the Inpatient Prospective Payment System can be quite a challenge (see below for key references!), but MediRegs subscribers can know right now with our MS-DRG electronic codebook, MS-DRG Grouper, and MS-DRG Calculator. We’ve recently released a significantly improved provider-specific MS-DRG calculator, powered by New Health Analytics. This calculator demonstrates MS-DRG payments under the Inpatient Prospective Payment System and includes the following enhancements:

Coding is easier with electronic references

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Every day, I hear from clients who are frustrated by having to access so many different references, including payer websites, encoders, paper references, and the government websites. It is always rewarding to train new users on the Coding Suite, seeing the “Aha!” moments when they realize that they can get all of the information they need in one source.

Inpatient PPS Rule - Easier to Understand in E-Book Format

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CMS has published the FY2015 IPPS Final Rule Rule, and MediRegs makes reading and understanding this rule easier with our electronic book version and payment data files. In this blog article, I will tell you where to find IPPS resources and what to expect in your product alerts.

Webinar

For a quick review of the FY2015 IPPS Rule, check out the Presentation Slides from our FY2015 IPPS Final Review webinar.

ICD-10 Delay Provides Opportunity for Data-Based Assessment and Planning

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By now, we all have come to realize that ICD-10 preparation is not a boiler-plate process; each organization has it's own unique challenges and opportunities. The delay gives every organization a chance to take a careful look at their own specifics - and a good place to start is the bottom line! Do you have a solid understanding of the payment impact your organization will face under ICD-10?

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