Risk

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.

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.

Gain clarity into 2015 IPPS & OPPS Final Rules

Every year we provide in-depth learning covering both the Inpatient Hospital PPD (IPPSFinal Rule and the Outpatient Prospective Payment System (OPPS) Final Rule. This year we covered the important issues in these Final Rules, as well as provided practical suggestions for how providers should respond to the changes from these new Rules, in two online webinars.

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