Q:I’m looking at the HCC information on the CMS website and am having trouble navigating it. How can I find the current year CMS-HCC list without the count variables model (drop list)? What about the current year ICD-10-CM and...Read More »
About 30% of ED visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional healthcare costs.Read More »
An inpatient study published in the Journal of the Academy of Nutrition and Dietetics analyzed a community hospital’s monthly reports for malnourished patients admitted between March 2015 and June 2017.Read More »
Insufficient documentation. That’s the biggest reason for improper payments for Healthcare Common Procedure Coding System (HCPCS) code 99234, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date,...Read More »
by Susan Schmitz, JD, RN, CCS, CCDS, CDIP
If you’re anything like me, I imagine you were quite relieved when the fiscal year (FY) 2020 inpatient prospective payment system (IPPS) final rule came out. The proposed rule with its thousands of CC and hundreds of MCC downgrades proved...Read More »
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary...Read More »
Q: I have a question about DRG 963. I’ve heard that we need three different trauma diagnoses from at least two different body site categories for this DRG. The DRG Expert has a list of all diagnoses under DRG 963, but it doesn’t...Read More »
