Electronic Code Sets

Understanding non-covered codes – help for denials management and pre-payment review edits

Rayellen Kishbach's picture

Wouldn't it be great if there was just ONE LIST of procedure codes published somewhere by Medicare to identify non-covered services? Unfortunately, there isn’t one, but a quick review of the information that is provided by Medicare can get you there.

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.

Understanding MS-DRG Grouping under ICD-10

Rayellen Kishbach's picture

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.

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.

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.

Coding is easier with electronic references

Rayellen Kishbach's picture

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.

Confused by NCCI Edits?

A smart customer reached out with a question about what looked like a conflict - that a modifier was allowed in one setting but not another for the same two codes. While this is common (NCCI has 2 versions - Hospital and Physician), the investigation lead to a great example that illustrates an important issue with how CMS can introduce retroactive changes.

Physician NCCI

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