News: Audit activity set to pick up pace in 2016
CDI Strategies, April 28, 2016
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
This will be a big year for audits between the new Recovery Auditors hitting the ground later this year, the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) now focusing on the 2-midnight rule, and a continued increase in managed care audits, Dawn Crump, MA, SSBB, CHC, vice president of audit management solutions for CIOX Health in Alpharetta, Georgia, told HIM Briefings in its May edition.
Recovery Auditors will likely spend 2016 focusing on diagnosis-related group (DRG) audits and medical necessity reviews. These audits will likely focus on reviewing medical necessity for procedures, tests, and treatments in relation to what the Payment Integrity Manual states should be captured in the health information. Records that do not capture information related to local and national coverage determinations will likely be the low-hanging fruit if the Recovery Auditors are approved to focus on these reviews, Crump says.
Also, auditors are getting up to speed on ICD-10 now, which means organizations should also be taking steps to ensure it is ready when the time comes, Crump says. "The basic audits are still ongoing, but most providers I have spoken with are cautiously optimistic because they are not seeing ICD-10 denials yet," says Crump who warns that ICD-10 examinations should pick up in the latter half of 2016.
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Related Products
Most Popular
- Articles
-
- CMS seeks comment on quality measures
- Practice the six rights of medication administration
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- OB services: Coding inside and outside of the package
- ICD-10-CM coma, stroke codes require more specific documentation
- Nursing responsibilities for managing pain
- Q&A: Primary, principal, and secondary diagnoses
- Skills of effective case managers
- Clearing up the confusion: CPT codes 76376 and 76377
- E-mailed
-
- Coronavirus vaccination: 4 best practices for communicating with patients
- Grievances, Complaints, and Patients’ Rights
- Keyes Q&A: Generator lighting, fire dampers, eyewash stations, ISLM fire drills
- Including 46600 in E/M leveling systems
- Five keys to creating a CHF disease management program
- Fetal non-stress tests represent important part of maternal and fetal health
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Know how to correctly code each procedure an otolaryngologist can perform on turbinates
- Coding Clinic reiterates guidelines for provider documentation
- CMS creates web portal for questions about 1135 waivers, PHE
- Searched