CMS’ Recovery Auditors (previously called Recovery Audit Contractors, now associated with the Recovery Audit Program [RAP]), collected nearly $400 million in overpayments from October 1 through December 31, 2011,...Read More »
Fifty-eight percent of claims billed with MS-DRG 246, percutaneous cardiovascular procedure with drug-eluting stent, with MCC or four-plus vessels/stents, were denied by Trailblazer Health Enterprises, LLC, the Medicare Administrative Contractor for Jurisdiction 4(Texas, New Mexico, Colorado,...Read More »
When hospitals appeal their denials they typically win. The AHA's RACTrac report indicates that hospitals appeal more than 40% of their denials with a roughly 75% success rate.
That’s where CDI professionals come in.Read More »
Malnutrition codes proposed for CC status; 584.8 for downgrade
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 inpatient prospective payment system (IPPS) proposed rule, released April 24. The 2.3% is a...Read More »
Documentation in today’s records may affect payments in FY 2014, 2015
Fail to reduce costs or fail to meet quality measures and your facility could lose out on those incentive payments—a loss of up to 1% of all MS-DRG payments in FY 2013, and up to 2% by 2017. In July, CMS...Read More »
Editor’s note: The following is an excerpt from ACDIS’ letter to CMS regarding the inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2013, sent on June 11, 2012. ACDIS is pleased to comment on the proposed changes to the Medicare Hospital...Read More »
Q: I was interested in further discussion about cystic fibrosis coding. I am conducting an audit on MS-DRGs 177, 178, and 179, Respiration infections and inflammation with MCC...Read More »
CMS recently published a draft ICD-10 MS-DRG definitions. According to the website, the definitions are displayed in 'grouper logic order,' meaning that the MS-DRGs are listed in the order in which the grouper recognizes them. “This enables users to see instances where grouper logic order...Read More »
