Since January, both President Trump and Republican leaders in Congress have talked about a three-step process for repealing and replacing the Patient Protection and Affordable Care Act (ACA). While the first six months of the Trump administration has seen mixed results, its efforts to reign in or hold back regulations, combined with its delay in filling lower-level agency roles, has impacted regulatory review and issuance of new regulations. So, despite Congress’ inability to pass legislation to change parts of the ACA, there is still plenty for providers to be concerned about.
Long Term Care (LTC) organizations and the integrated delivery networks to which they belong are now challenged to escalate regulatory compliance—particularly in the area of Information Security—to the same priority level as Patient Safety and Quality.
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.
Managing regulatory and compliance risk in the face of constantly evolving rules and guidelines is a significant challenge for both payers and providers, creating a pressing need for a best-in-class system to consistently support regulatory, reimbursement and compliance professionals in healthcare.
HIM professionals now engage across the healthcare enterprise, including ambulatory, acute, and postacute settings, thanks to their necessary involvement in implementing CMS' risk adjustment and Hierarchical Condition Category (HCC) coding system.
