Clinical documentation improvement (CDI) programs have become commonplace in inpatient care in the past decade due to continual flux in reimbursement rules and increased scrutiny of claims by third-party payers. With expanding volumes at outpatient facilities as a result of a shift away from higher-cost acute care, payers are using audits and other tools to ensure physicians in offices and … Read More
Much attention has been paid to the explosion of telehealth technology and services during the pandemic. It is viewed as one of the bright spots in an otherwise bleak year in the business of healthcare. Mostly, the action has been in telehealth visits – doctors discussing care with patients over whatever communication devices they have, including phones. Most observers think … Read More
A joint presentation from Salud, MedAstute Consulting and Apollo HIT The operating revenue outlook for most healthcare providers is dire, as patients are only slowly returning to scheduled medical encounters. With the changes to regulations as part of the response to COVID, telehealth services have become a lifeline for many providers. During the pandemic, hurdles to adopting telehealth have mostly … Read More
The Centers for Medicare & Medicaid Services’ 3-year-old Patients over Paperwork initiative, designed to free doctors and non-physician practitioners to focus more on patient care, has led to the first major revision of evaluation and management (E&M) office visit codes in more than a quarter century. The changes are limited to medical office/outpatient services, but they are significant and will … Read More
Value-based payment has been steadily growing in healthcare in the past few years, thanks to programs such as the Hospital Inpatient Value-based Payment Program and the Merit-based Incentive Payment System (MIPS, part of the Quality Payment Program for physicians). More recently, this movement has gained new agency due to risk-based programs in the commercial payer market. For providers, these initiatives, … Read More
Evaluation and management (E/M) services occur in the hospital as inpatient or observation visits. They also occur in nursing homes, physicians’ offices, emergency departments and even in the home. While there have been guidelines since 1995 and guidelines updated in 1997, both of which are still used, E/M services still have been vulnerable to fraud and abuse. In 2021, major … Read More
When you think of America’s opioid crisis, your thoughts probably don’t quickly turn to medical codes. And yet, the fact is that when medical crises arise, code changes are made to accurately capture and support needed services. Opioid addiction, with millions of people affected and horrendous loss of life as well as broken lives, is certainly such a crisis, perhaps … Read More
There are often unintentional disconnects between AR and HIM, as coders focus on coding guidelines, medical necessity, and supportive documentation, but may not be aware of specific written payer instructions, payer manuals or unique contracts. This not only can create unnecessary denials or improper code changes, but it also can result in tensions between the two departments. Read the article.
The Centers for Medicare and Medicaid Services has unbundled the four existing CPT codes for Interprofessional Consultative Services – 99446-99449. It also created two new codes in 99451-99452 under Interprofessional Internet Consultation services. The new codes further allow the treating provider to be paid for the efforts made in initiating the consultation. Read the article.
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