Basically, HCCs predict an individual beneficiary’s healthcare expenditures relative to the average beneficiary. CMS uses the scores to adjust...Read More »
Lisa A. D. Lanier, BS, CCS, covers ensuring medical necessity for common outpatient services, including improving documentation to secure diagnoses needed to support diagnostic tests and procedures performed in the ED and clinic setting.
Victor Freeman, MD, MPP explains the need for evidence-based diagnostic criteria in the ED, why sepsis, acute renal failure, and acute respiratory failure are so poorly documented in the ED, and why capturing these diagnoses is critical for ensuring/promoting diagnosis capture in the rest of the...
Trey A. La Charité, MD; Lynn H. Lowery, CPC, CFPC, explore how healthcare reform is rapidly changing to reimburse providers for outcomes of care as opposed to fee for service and how primary care physicians need to be the focus of your CDI efforts in the outpatient setting.
Mark Michelman, MD, MBA, provides strategies to handle prepayment reviews--a CMS, eight state
pilot that allows fiscal intermediaries up to 60 days to review a claim for payment.
Adele L. Towers, MD, MPH, FACP, discusses the effectiveness of an automated CDI process in risk adjustment coding and best methods to leverage CDI expertise to manage automated processes and network flows that will greatly improve coding documentation.
Sarah C. Mendiola, Esq., LPN, CPC, presents actual examples of costly denials that could have been prevented with CDIS intervention. These include 2-midnight rule denials, medical necessity for major joint replacement (as outlined by CMS), and justification of MCCs that are difficult to support...
Richard D. Pinson, MD, FACP, CCS provides knowledge of Medicare's physician VBPM to successfully leverage physician motivation to provide complete and precise documentation terminology.
