In May, we expect to see the release of the International Classification of Diseases, 11th Edition, for Mortality and Morbidity Statistics (ICD-11-MMS) by the World Health Organization. Work will then begin in the U.S. to adapt it for our clinical use as ICD-11-CM. Hopefully, with the benefit of foresight and lessons learned from the past, we will not reenact the pain we all had with the ICD-10-CM/PCS implementation.
Project REFRESH brought the deletion of many standards and elements of performance (EP), and you will see even more changes beginning in January. This column will also review the changes to the Evidence of Standards Compliance (ESC) corrective action plan for Requirements for Improvement (RFI) that must be submitted after a survey.
HIPAA compliance and enforcement saw its share of highs and lows in 2017. As the year comes to a close, it’s a good time to look back on what your organization has learned—in terms of personal growth and lessons gleaned from other organizations.
21st Century Oncology, a national network of cancer providers headquartered in Fort Myers, Florida, came under scrutiny by the Department of Justice (DOJ) and the Office for Civil Rights (OCR) earlier this year. In December, the organization agreed to a $26 million settlement with the DOJ and a $2.3 million settlement with OCR. 21st Century Oncology filed for bankruptcy in May.
The term and concept of revenue integrity began emerging early in the 21st Century. This emergence was partly in response to concerns that phrases such as maximizing and optimizing revenue might imply gaming or failure to comply with regulations, laws, and business ethics.
Coding experts take a look at changes to ICD-10-PCS, including guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement.
Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.
Documentation and coding based on time requires knowledge about the general principles of E/M documentation, common sets of codes used to bill for E/M services, and E/M services providers.
