by Deanne Wilk, BSN, RN, CCDS, CDIP, CCDS-O, CCS
Patient safety and quality of care are forerunning concerns for organizations today. Not only do we want to ensure our patients are receiving high-quality care, we want to ensure care is safe and effective. We need to examine how...Read More »
In July 2020, the Office of Inspector General (OIG) under the Department of Health and Human Services released a report of findings from audits to determine hospital compliance with Medicare billing requirements when...Read More »
The Office of Inspector General (OIG) will be conducting a second round of audits to determine whether acute care hospitals are being inappropriately reimbursed for outpatient services provided to inpatients, according to an update to its...Read More »
Aside from a defense attorney mindset, there are additional processes that can improve your chances of winning an appeal and successfully overturning a denial.
When Kimberly Huff, COC, CCDS, clinical validation denials coordinator at Providence St. Joseph Health,...Read More »
Because of the industry’s confusion over sepsis criteria sets, organizations find it difficult to decide which guidelines to follow for their sepsis documentation.
“Many third-party payers have adopted Sepsis-3 criteria, which is not in line with what CMS is doing,” says ...Read More »
Typically, CDI specialists’ work happens before the bill drops, while the patient is in the hospital or immediately following discharge before final coding. Even with the most stringent CDI processes and an exceptionally engaged physician group, we know that...Read More »
It used to come annually. Every October, compliance officers across the country would delve into its pages to determine what the Office of the Inspector General (OIG) planned to investigate for the coming calendar year—and what their facility’s risk level might be.
Almost half of hospitals in the United States will be getting lower payments for Medicare patients due to their readmission history, according to an analysis reported in Kaiser Health News...Read More »
