Trying to convince physicians that good documentation has “something in it for them” is a battle that CDI specialists fight each day. But a new CMS initiative that bundles physician and hospital payment into one lump sum could represent a long-term, revolutionary solution to that age-old...Read More »
Out of 88 claims for MS-DRG 246 (percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents with a length of stay less than or equal to two days) reviewed during a recent probe audit, TrailBlazer Health Enterprises, LCC, fully denied 65 of them,...Read More »
Being described as "worse" in a CMS HospitalCompare data file is a dubious distinction.
A recent HospitalCompare list identifies 292 hospitals with 30-day readmission rates that are the highest in the nation in at least one of three disease categories— acute myocardial infarction,...Read More »
It started with two courageous coders who knew the query process where they worked at Johns Hopkins Bayview Medical Center, Inc., in Baltimore, wasn't quite right--or compliant.
Specifically, the hospital employed a physician who worked in the billing department to review clinical...Read More »
Healthcare providers in the A/B MAC jurisdiction 1 have a problem—a paid claims error rate that’s nearly twice the national average for Part B claims, according to a recent letter from...Read More »
In 2007, CMS began monitoring claims for hospital-acquired conditions (HAC), which are conditions that occur after the physician writes the inpatient admission order and that could have been reasonably prevented through the application of evidence-based guidelines and best practices. Today,...Read More »
