Hospital-acquired and community-acquired pneumonias do not translate directly to medical codes. When querying a physician, ask him or her to identify the organism (e.g., gram negative, Proteus mirabilis, Klebsiella, or aspiration).

Ask the expert: Are there any resources available to learn more about the Medicare Claims Review Program, including medical review, Medically Unlikely Edits, National Correct Coding Initiative edits, Comprehensive Error Rate Testing Program, and Recovery Audit Contractors?

The initial investment in legal counsel up front outweighs the risk of misunderstanding conflicting laws after the fact. In particular, with the migration from paper charts to an EHR, various healthcare professionals will have different opinions about which documents are considered part of the legal health record.

As your HIM department prepares for the national expansion of the Recovery Audit Contractor (RAC) program in 2010, there is no better source of advice than hospitals in states where RACs are already present.