The updates to ICD-10-CM and ICD-10-PCS that become effective April 1 were released in mid-January. The updates include 42 new diagnosis codes. The significant changes to the ICD-10-CM guidelines are the following: A.19 – Code Assignment and Clinical Criteria This section has added a new sentence: “If there is conflicting medical record documentation, query the […]
The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for Affordable Quality Healthcare, […]
Not Coding the Highest Level When it comes to ICD-10 coding, a coder’s job is to code to the highest level of specificity. This means detailing and abstracting the most information out of the medical reports from the provider and taking accurate notes. It also means knowing the medical terminology for both procedures and diagnoses. […]
Don’t assume the codes you’ve been using to report drugs and biologicals still apply. The January 2023 update to the HCPCS Level II code file from the Centers for Medicare & Medicaid Services (CMS) includes 184 new codes for reporting services and supplies. Approximately 36 of the new codes were created to separately identify products […]
Erica Remer, MD, CCDS, a Member Board of Directors of American College of Physician Advisors, have been talking about improving the electronic medical record and making it more end-user-friendly. Today, she grouses about documentation in general. Her husband, who is a radiologist, and she were commiserating at how awful and uninformative provider documentation has become […]
A new study found that people with diabetes who switched to a high deductible health plan (HDHP) were more likely to experience serious complications. Understand your insurance plan and what it covers. A January 2023 study led by Dr. Rozalina McCoy, endocrinologist and health services researcher at Mayo Clinic, found that people with diabetes who […]
The average health system saw 110,000 claim denials due to prior authorization and other factors in 2022, a recent study says. KEY TAKEAWAYS: Revenue cycle leaders are placing denials management at the top of the list of areas to improve for 2023. Denials rose to 11% of all claims last year, up nearly 8% from […]
The omnibus spending bill continues telehealth waivers for two years past the PHE, but was silent on the issue of reimbursement. The federal government extended telehealth waivers for two years, but the current higher rate of reimbursement is in place only through the end of this year. During the public health emergency, the Centers for […]
One Medicare Advantage plan used the Ribbon tool to focus on quality measures and saw a 342% net increase in users achieving a 4+ star rating. Increased data transparency between health plans and providers on care and coding gaps results in higher compliance, process improvement and positive behavior changes among network providers, according to a […]
Contrary to widespread hopes, the growth in telehealth brought on by the COVID-19 pandemic probably won’t lower health care costs. But it may make some services more widely accessible. A new Kaiser Family Foundation study compares average 2020 commercial insurance payments for evaluation and management and mental health therapy claims for services provided via […]