Integrating facility and professional fee coding into one centralized department model can help organizations make the most of advances in technology and manage costs.
Payers rely heavily on the use of data and data analytics to manage their risk. Follow these tips for using payer guidelines to understand what they’re looking for and how to improve documentation.
Social determinants of health are social factors, such as homelessness, illiteracy, a history of childhood trauma, and joblessness or underemployment, that can affect a person’s health. Coding for these factors is important because CMS officials now use some of them to adjust quality measures for patients who are dual-eligible for Medicare and Medicaid, and coding these factors may help shape future health policy.
In the April 2018 OPPS update transmittal, CMS announced new HCPCS code C9749 (repair of nasal vestibular lateral wall stenosis with implant[s]), effective April 1, 2018.
The recently released 2019 ICD-10-CM update adds some codes to allow additional diagnoses to be reported while adding others for greater specificity. The update includes more than 600 additions, deletions, and revisions.
Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.
The Hierarchical Condition Categories (HCC) risk-adjustment methodology is beginning to surface more frequently in both the acute and primary settings. Use these expert tips to help improve complete, compliant HCC capture.
When evaluating a code edit, it’s necessary to understand exactly when or where in the claim or billing process the edit arose. Look to coding guidance to help edit resolution efforts.
