ICD-10

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

Keeping up with MS-DRG Revisions

Rayellen Kishbach's picture

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.

Rayellen Kishbach's picture

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.

Dateline San Diego: AHIMA: This is What is Happening in San Diego

Originally Posted in ICD10monitor.com

Listen to the Talk Ten Tuesday Podcast

As always, AHIMA delivers a great convention filled with the latest and greatest industry knowledge and technology! Two of the greatest and most meaningful takeaways this year are related to Big Data and ICD-10, both of which tie nicely together.

ICD-10 Resources: Four Educational Webinar Replays

As we near the one-year mark to the updated ICD-10 deadline, we are continuing to provide ongoing educational resources to directly address the ongoing risks and challenges relating to the adoption of ICD-10 throughout your organization. Visit our online resource center to watch a replay of our four most recent ICD-10-related educational webinars:

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

Rayellen Kishbach's picture

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?

Rayellen Kishbach's picture

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.

Demystify Inpatient Reimbursement with Simple Tools

Rayellen Kishbach's picture

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:

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