Corporate Compliance

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• ACDIS/AHIMA Query Escalation Policies Released

  In the April edition of the CDI Journal, ACDIS published the joint ACDIS/AHIMA practice brief on “Guidelines for Achieving a Compliant Query Practice.” The intent of this practice brief is to maintain the integrity of the coded healthcare data. The purpose of the query process outlined is to ensure appropriate documentation appears in the health record. Additional policies may need to be implemented when questions arise regarding the clinical validity in practitioner documentation.

• June, so soon?

  As we break for a long weekend and the unofficial start of summer, I want to tell you about a couple of items on the Credentialing Resource Center roster.

• Note from the instructor: Manual medical review by Recovery Auditors of outpatient therapy claims begins April 1

  During the last quarter of 2012, hospital outpatient departments temporarily fell under the therapy caps and manual medical review provisions as required under the Middle Class Tax Relief and Job Creation Act. On January 2, 2013, the American Taxpayer Relief Act revised those provisions that impacted outpatient therapy services, including those provided in hospital outpatient departments for services furnished between January 1 and December 31, 2013. Click on the link above to learn about the details.

• Note from the instructor: Details released on Part A to B rebilling ruling

  Most of you reading this likely already know that CMS released a ruling on March 13 that revises Part B inpatient billing in hospitals, but how exactly are providers supposed to go about doing it? This article takes a look at the rebilling format, as well as denials that are subject to the ruling, timeframes for rebilling, and special considerations for pending appeals. Click on the link above to learn about the Part A to Part B rebilling details.

• HIPAA Q&A

  Chris Apgar, CISSP, CEO and president of Apgar & Associates, LLC answers your HIPAA questions on patient preference, incidental disclosures, and email blasts in this HIPAA Q&A. Click the link above to read more.

• CMS issues proposed changes to Part B inpatient billing in hospitals

  Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed not reasonable and necessary may rebill the claim under Part B. Click the link above to read the CMS notice of ruling, the proposed rule, and an HCPro analysis.

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