Health Information Management Articles by Topic: MS-DRGs
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CDI Strategies, Issue 26, December 18, 2014
Struggling to identify the clinical indicators needed to qualify a diagnosis as a...
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CDI Strategies, Issue 19, September 11, 2014
Q: We’re having a lot of discussions with physicians right now and need to get some clarity...
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CDI Strategies, Issue 18, August 28, 2014
The 2015 IPPS final rule, released August 4, focuses on quality initiatives and includes no...
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HIM-HIPAA Insider, Issue 18, May 5, 2014
Quality measures are at the top of the list of potential changes outlined in CMS’ 2015 IPPS...
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Briefings on Coding Compliance Strategies, Issue 2, January 29, 2014
Whether you work in a dedicated children’s hospital or a general hospital with a pediatric...
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Briefings on Coding Compliance Strategies, Issue 2, January 29, 2014
Inpatient coders will see an entirely new coding system October 1 when they begin officially using...
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Briefings on Coding Compliance Strategies, Issue 2, January 29, 2014
The UHDDS defines principal diagnosis as the condition established after study to be chiefly...
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CDI Strategies, Issue 24, November 21, 2013
"[Recovery Auditors] are doing a really good job at identifying the patients who don't have...
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CDI Strategies, Issue 15, July 18, 2013
Sepsis. Ureosepsis. Severe Sepsis. Systemic inflammatory response syndrome (SIRS). Bacteremia...
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CDI Strategies, Issue 8, April 11, 2013
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the...
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CDI Strategies, Issue 1, January 3, 2013
Depending on how they are sequenced, CC and MCC conditions can have a direct effect on MS-DRG...
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CDI Strategies, Issue 24, November 21, 2012
By Don Butler, RN, BSN
During a recent CDI Talk conversation, I alluded to data available in the...
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CDI Strategies, Issue 22, October 25, 2012
Q: I have heard that there is an AHA Coding Clinic for ICD-9-CM, which states that the exacerbation...
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CDI Strategies, Issue 22, October 25, 2012
A clear understanding of the definition of principal diagnosis and the factors that play into...
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JustCoding News: Inpatient, Issue 39, September 26, 2012
Coders are the backbone of an organization’s fiscal health. Timely coding leads to timely...
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JustCoding News: Inpatient, Issue 39, September 26, 2012
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule, released August...
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JustCoding News: Inpatient, Issue 33, August 15, 2012
CMS did not make any sweeping changes to its MS-DRG methodology as part of the 2013 IPPS final...
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JustCoding News: Inpatient, Issue 33, August 15, 2012
Physicians often use the acronyms IBS (which should indicate irritable bowel syndrome) and IBD...
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HIM-HIPAA Insider, Issue 5, August 6, 2012
Inpatient facilities received mixed news on proposed changes to the list of complications and...
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CDI Strategies, Issue 14, July 5, 2012
Determining when to code a post-surgical complication as opposed to simply considering it to be an...
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CDI Strategies, Issue 10, May 10, 2012
“This claim was denied after review and it was determined that the documentation did not...
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JustCoding News: Inpatient, Issue 19, May 9, 2012
Although MS-DRGs have stolen the spotlight since CMS implemented them in 2007, hospitals are...
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JustCoding News: Inpatient, Issue 19, May 9, 2012
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year...
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CDI Strategies, Issue 9, April 26, 2012
CMS projects that payment rates to general acute care hospitals will increase by 2.3% in fiscal...
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CDI Strategies, Issue 7, March 29, 2012
CMS posted v29 of the ICD-10 MS-DRGs and an updated version of the v27 Medicare Code Editor (MCE...
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HIM-HIPAA Insider, Issue 10, March 6, 2012
The Revenue Cycle Institute has released a new white paper, “2011 Recovery Auditor...
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CDI Strategies, Issue 4, February 16, 2012
Fifty-eight percent of claims billed with MS-DRG 246, percutaneous cardiovascular procedure with...
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CDI Strategies, Issue 3, February 2, 2012
Q: I am fairly new to CDI and I have a nursing background. I’m trying to understand how...
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CDI Strategies, Issue 2, January 19, 2012
CMS recently published a draft ICD-10 MS-DRG definitions. According to the website, the definitions...
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CDI Strategies, Issue 2, January 19, 2012
Q:I have a question regarding sequencing. I would usually have sequenced 428.21 (heart failure) as...
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CDI Strategies, Issue 1, January 5, 2012
CMS recently released ICD-10 CC and MCC lists on its web site. It lists the diagnosis by ICD-10...
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JustCoding News: Inpatient, Issue 1, January 4, 2012
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS...
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CDI Strategies, Issue 27, December 22, 2011
Most of the cases that HIM professionals code are straightforward; some are more difficult, and a...
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CDI Strategies, Issue 27, December 22, 2011
Effective December 15, Trailblazer Health Enterprises, LLC, began prepay service-specific medical...
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CDI Strategies, Issue 27, December 22, 2011
Q:Does documentation such as “suggestive of” or “suspicious of” qualify as...
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CDI Strategies, Issue 24, November 10, 2011
Q:Can a patient have encephalopathy after a surgery? For example, a patient post surgery...
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HIM-HIPAA Insider, Issue 45, November 8, 2011
Q: One of our podiatrists documents “surgical debridement of devitalized tissue with...
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HIM-HIPAA Insider, Issue 39, September 27, 2011
The Program for Evaluating Payment Patterns Electronic Report (PEPPER), distributed either...
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HIM-HIPAA Insider, Issue 38, September 20, 2011
The FY 2012 IPPS final rule is out, and hospitals that are bracing for changes effective October 1...
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CDI Strategies, Issue 17, August 18, 2011
By Linda Renee Brown, RN, CCRN, CCDS, MA
One of the most confusing diagnoses to code and sequence...
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HIM-HIPAA Insider, Issue 33, August 16, 2011
It started with two courageous coders who knew the query process at Johns Hopkins Bayview Medical...
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HIM-HIPAA Insider, Issue 32, August 9, 2011
CMS released its final rule for the FY 2012 Inpatient Prospective Payment System integral to...
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CDI Strategies, Issue 16, August 4, 2011
Q: I am having trouble grasping the concept of “marrying” DRGs. Can you explain what...
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CDI Strategies, Issue 16, August 4, 2011
CMS released the Inpatient Prospective Payment System (IPPS) Final Rule, Monday, Aug. 1, reducing a...
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HIM-HIPAA Insider, Issue 25, June 21, 2011
Not sure where to focus your RAC preparations these days? Look no further than the Program for...
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HIM-HIPAA Insider, Issue 24, June 14, 2011
Provider-preventable conditions (PPC), including health care-acquired conditions (HCAC), are now...
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CDI Strategies, Issue 12, June 9, 2011
Q: With all the auditing going on I would like to find out how effects CDI programs in other...
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HIM-HIPAA Insider, Issue 22, May 31, 2011
If you haven't already heard, HAC data is now publicly available on CMS' website, and as of April...
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CDI Strategies, Issue 10, May 12, 2011
Hospitals can start experimenting with how new ICD-10-CM/PCS codes will translate to MS-DRGs since...
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CDI Strategies, Issue 10, May 12, 2011
Q:I’ve heard different opinions between the coders and some of our CDI consultants regarding...
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HIM-HIPAA Insider, Issue 18, May 3, 2011
Exactly how will ICD-10 affect MS-DRG assignment? As coders began learning the intricacies of...
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CDI Strategies, Issue 9, April 28, 2011
CMS expects a year-over-year reduction of 0.5% in payments to acute care hospitals under the...
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CDI Strategies, Issue 4, February 17, 2011
A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the...
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HIM-HIPAA Insider, Issue 7, February 15, 2011
A patient’s medical record could include a laundry list of diagnoses, but not all of these...
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Briefings on Coding Compliance Strategies, Issue 2, February 1, 2011
Learn about reporting secondary diagnoses, assigning the POA indicator, ICD-10 procedure...
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HIM-HIPAA Insider, Issue 2, January 11, 2011
With an ever-growing list of RAC-targeted MS-DRGs and a host of coding compliance traps that...
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HIM-HIPAA Insider, Issue 1, January 4, 2011
Briefings on Coding Compliance Strategies recently asked advisory board members about the best...
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Briefings on Coding Compliance Strategies, Issue 1, January 1, 2011
Learn about coding issues to include in your 2011 audit plan, the benefits of online social...
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Briefings on Coding Compliance Strategies, Issue 12, December 1, 2010
Learn about the OIG work plan, acute kidney injursy, acute kidney failure, documentation and DNFB...
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HIM-HIPAA Insider, Issue 46, November 23, 2010
Now that RAC medical necessity audits are well under way, the focus has shifted from anticipatory...
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HIM-HIPAA Insider, Issue 44, November 9, 2010
Q: I heard that code V64.05 (vaccination not carried out because of caregiver refusal) has been...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2010
Learn about medical necessity audits, linking signs and symptoms with definitive conditions...
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CDI Strategies, Issue 21, October 14, 2010
by Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS
I often wondered how the ICD-9-CM code set would...
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CDI Strategies, Issue 20, September 30, 2010
By Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS
I recently received a fortune cookie from a...
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CDI Strategies, Issue 20, September 30, 2010
Q: Whenever we get a trauma patient, it’s either very easy to get to the multiple significant...
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HIM-HIPAA Insider, Issue 38, September 28, 2010
The FY 2011 inpatient prospective payment system final rule released July 30 includes the usual...
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HIM-HIPAA Insider, Issue 35, September 7, 2010
The following four case studies test your knowledge of correct principal diagnosis (PDX...
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CDI Strategies, Issue 18, September 2, 2010
Confusing coding guidelines and insufficient documentation have made neoplasms a target area as...
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Briefings on Coding Compliance Strategies, Issue 9, September 1, 2010
Learn about the FY 2011 IPPS final rule, the three-day payment rule, documentaiton and coding...
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HIM-HIPAA Insider, Issue 13, August 24, 2010
The electronic Program for Evaluating Payment Patterns Electronic Report (PEPPER) contains data for...
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HIM-HIPAA Insider, Issue 32, August 17, 2010
Calculating a hospital’s case-mix index (CMI) is one way to gauge a CDI program’s...
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CDI Strategies, Issue 16, August 5, 2010
On July 30, CMS issued the inpatient prospective payment system (IPPS) final rule to update...
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HIM-HIPAA Insider, Issue 30, August 3, 2010
On July 30, CMS issued the inpatient prospective payment system (IPPS) final rule to update...
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Briefings on Coding Compliance Strategies, Issue 8, August 1, 2010
It shouldn’t come as a surprise that HealthDataInsights—the RAC for Region D—is...
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Briefings on Coding Compliance Strategies, Issue 8, August 1, 2010
Learn about avoidable V code traps, why you shouldn't bypass coding rules for more money, why...
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HIM-HIPAA Insider, Issue 26, July 6, 2010
Medically unnecessary services and incorrectly coded items had the highest amounts of RAC...
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Briefings on Coding Compliance Strategies, Issue 7, July 1, 2010
Inpatient admissions requiring mechanical ventilation tend to be high-dollar cases, which is...
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CDI Strategies, Issue 13, June 24, 2010
Q: Do you know of any recommended benchmarks or targets we should be hitting? For example...
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HIM-HIPAA Insider, Issue 24, June 22, 2010
The fiscal year (FY) 2011 IPPS proposed rule released April 19 addresses several highly debated...
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HIM-HIPAA Insider, Issue 24, June 22, 2010
In the July issue of MRB, you’ll find the following articles and more!
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Briefings on Coding Compliance Strategies, Issue 6, June 1, 2010
The fiscal year (FY) 2011 IPPS proposed rule released April 19 addresses several highly debated...
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Briefings on Coding Compliance Strategies, Issue 6, June 1, 2010
Learn about the three-day payment rule, FY 2011 IPPS Proposed Rule, discharge disposition codes...
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HIM-HIPAA Insider, Issue 19, May 18, 2010
MS-DRG 432 (cirrhosis and alcoholic hepatitis with MCC) is one of many MS-DRGs slated for RAC...
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HIM-HIPAA Insider, Issue 18, May 11, 2010
Aside from being a catchy acronym, PEPPER (Program for Evaluating Payment Patterns Electronic...
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HIM-HIPAA Insider, Issue 16, April 27, 2010
Overcoding and coding based on insufficient documentation may be one reason why RACs are auditing...
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Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010
Coders don't need a RAC audit to tell them that reporting inpatient wound care is particularly...
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Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010
Dust off a medical terminology book and start reviewing anatomy and physiology. This may be the...
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Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010
Was it present on admission (POA) or did it develop during the patient's stay?
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Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010
In this issue, we detail how to ensure compliance and date accuracy by auditing...
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HIM-HIPAA Insider, Issue 5, February 9, 2010
HIM directors can evaluate their hospital’s potential risk for overcoding and unnecessary...
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HIM-HIPAA Insider, Issue 5, February 9, 2010
As RACs begin to roll out complex reviews and request medical record documentation, compliant...
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HIM-HIPAA Insider, Issue 3, January 19, 2010
In recent weeks, HealthDataInsights (HDI) has added dozens of new issues to its CMS-approved list...
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HIM-HIPAA Insider, Issue 3, January 19, 2010
CMS has once again contracted with the TMF Health Quality Institute to release Program for...
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CDI Strategies, Issue 26, December 24, 2009
Q: What are the differences between the MS-DRG and the APR-DRG systems?
A:Garri L...
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HIM-HIPAA Insider, Issue 49, December 8, 2009
Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...
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Briefings on Coding Compliance Strategies, Issue 12, December 1, 2009
Inside:
New E codes require detailed documentation
OIG focuses on hot-button issues in 2010 Work...
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HIM-HIPAA Insider, Issue 46, November 17, 2009
Clinical knowledge is an essential element for capturing severity and MS-DRG assignment, according...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2009
The American Hospital Association’s Coding Clinic for ICD-9-CM is one of the most important...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2009
Some of the major code groupings undergoing change this year include more specificity to the...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2009
The 2010 IPPS final rule included several changes related to MS-DRGs, complications and...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2009
Inside:
Prepare for ICD-10 with anatomy/physiology education
Determine your coders’ need...
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Briefings on Coding Compliance Strategies, Issue 10, October 1, 2009
In the September BCCS, we published an article with Coding Clinic advice on coding anemia secondary...
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Briefings on Coding Compliance Strategies, Issue 10, October 1, 2009
Although undercoding is always a concern for facilities, potential upcoding is just as serious a...
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Briefings on Coding Compliance Strategies, Issue 10, October 1, 2009
Coding has continually evolved over the past 10 years, and it will continue to change with the...
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Briefings on Coding Compliance Strategies, Issue 10, October 1, 2009
Inside:
Use productivity benchmarks to set coding standards
Roller-coaster fall results in...
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HIM-HIPAA Insider, Issue 39, September 29, 2009
The present-on-admission (POA) indicator refers to conditions that are present at the time an order...
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CDI Strategies, Issue 18, September 3, 2009
Following a targeted review of 250 claims with DRG 247, TrailBlazer, the Medicare Administrative...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s Note: The following tip was excerpted from the article “Tips for problematic...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s note: The following Q&A first appeared in the August 20, 2009, edition of CDI...
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HIM Briefings, Issue 9, September 1, 2009
Just because coders have been reporting the present-on-admission (POA) indicator for nearly...
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Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009
In this issue, we dissect the final 2010 IPPS rule, plus discuss the three new NCDs for never...
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Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009
CMS delayed a payment reduction, but changed MS-DRG weights.
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CDI Strategies, Issue 16, August 6, 2009
It's important to develop a structured process of performing quality audits of your CDI staff, says...
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HIM-HIPAA Insider, Issue 31, August 4, 2009
Though many hospitals had feared a 1.9% reduction in payment for 2010, they will actually see a...
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CDI Strategies, Issue 15, July 23, 2009
Q: When coded, will the five ICD-9 diagnosis codes which turn off if the patient expires for use in...
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HIM-HIPAA Insider, Issue 29, July 21, 2009
Certain areas of the patient’s record will most likely provide important clues to the coder...
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HIM Briefings, Issue 7, July 1, 2009
This month’s expanded issue includes our 4-page quarterly insert about electronic health...
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Briefings on Coding Compliance Strategies, Issue 6, June 1, 2009
Every so often, I’m reminded of how important it is to code accurately and in the proper...
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Briefings on Coding Compliance Strategies, Issue 6, June 1, 2009
When CMS released its May 1 proposal, hospitals received a mixed bag of news: There are minimal...
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CDI Strategies, Issue 11, May 28, 2009
CDI specialists who seek to alter code sequences in order to optimize CC/MCC capture and case mix...
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APCs Insider, Issue 19, May 15, 2009
Q: A patient is seen in the ED for laceration repair and then returns for suture or staple removal...
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HIM-HIPAA Insider, Issue 19, May 12, 2009
During the three-year RAC demonstration project, payment for several inpatient debridement...
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Briefings on Coding Compliance Strategies, Issue 5, May 1, 2009
Four aspects of the 2009 OIG Work Plan apply to inpatient hospitals and coders. Find out how you...
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HIM-HIPAA Insider, Issue 17, April 28, 2009
On April 13, CMS announced a pilot project to reduce rates of hospital readmissions. The Care...
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CDI Strategies, Issue 3, February 5, 2009
Note: ACDIS appreciates receiving questions from our readers. We cannot promise to answer every...
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Briefings on Coding Compliance Strategies, Issue 1, January 1, 2009
Get to know your bleeds to ensure proper coding by Robert S. Gold, MD Consider the following...
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Briefings on Coding Compliance Strategies, Issue 12, December 1, 2008
Since October 1, 2007, providers have been adapting to a revised hospital inpatient reimbursement...
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Briefings on Coding Compliance Strategies, Issue 12, December 1, 2008
CMS discusses RAC expansion, ICD-10, and never events CMS hosted a Hospital & Hospital Quality...
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Briefings on Coding Compliance Strategies, Issue 12, December 1, 2008
by Robert S. Gold, MD Applying the present-on-admission (POA) indicator to pressure ulcers is no...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2008
Gastrointestinal (GI) bleed and its manifestations can be confusing without some insight into...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2008
The ICD-9-CM Manual provides many helpful tools you can use to your advantage. For example, despite...
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Briefings on Coding Compliance Strategies, Issue 11, November 1, 2008
Forty percent of Medicare admission denials relate to improper one-day stays. If this statistic...
