The Centers for Medicare & Medicaid Services (CMS) started rolling out post-payment audits again, as of Aug. 3, but now – after finding inconsistencies in the accuracy of some COVID-19 tests, and considering the fact that CMS has been paying an additional 20 percent to providers and facilities “treating patients with COVID or testing for COVID” – the agency has enacted a new mandate to qualify for the increased reimbursement. During the next live edition of Talk Ten Tuesdays, Terry Fletcher,...
Sep 01, 2020•30 min•Ep. 430
Plenty of time at home. Self-isolation. Binge-watching television shows. No commuting. Working remotely. You would think that with all the time spent at home these days, folks would be getting more and better sleep, right? Wrong! The truth is, according to Dr. Nick van Terheyden, that there are daunting obstacles to getting a good night’s sleep, with all the additional worries and fear induced by the COVID-19 pandemic and associated challenges in our economy and society. Reporting our lead story...
Aug 25, 2020•30 min•Ep. 429
It’s out and it’s already creating controversy: the Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) proposed rule, which becomes effective January 2021. The rule, issued Aug. 4, would eliminate the Medicare inpatient-only list of services while increasing the number of Ambulatory Surgical Center (ASC)-eligible procedures. The rule would also increase 340B payment cuts, and it looks to overhaul the hospital star-rating system. It’s an interesting ti...
Aug 18, 2020•29 min•Ep. 428
The Centers for Medicare & Medicaid Services (CMS) has announced two new payment initiatives, with one being the use of "counseling" to help stop the spread of COVID-19. CMS will make payment available to physicians and providers to counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested, and prior to the onset of symptoms. However, to get reimbursed for these services, there are protocols to follow, eligible providers to consider, and pl...
Aug 11, 2020•29 min•Ep. 427
COVID-19 is a disruptor of giant proportions. Case in point: The lead story for tomorrow’s Talk-Ten-Tuesdays was the ongoing COVID-19 pandemic, featuring Dr. John Foggle, who has spent the last three months working on the front lines in an urban, academic medical emergency department, treating COVID patients. Dr. Foggle had to cancel because he was asked to lecture on the deadly virus at Walter Reed National Medical Center. So, given the attention being given to the coronavirus, it’s not surpris...
Aug 04, 2020•29 min•Ep. 426
One day she’s consulting in Los Angeles. The next day she’s back in Indiana, with upcoming client calls scheduled at hospitals and physician practices in nearly every U.S. city and small town. Her frequent flyer miles would qualify for a round-trip to Mars. High-flying and always in demand as a speaker, Deborah Grider came crashing down, diagnosed with COVID-19 earlier this year. She’s recovering now – enough so that she wrote a personal account of her COVID ordeal for ICD10monitor. Grider will ...
Jul 28, 2020•29 min•Ep. 425
Choosing the proper office visit code can be confusing unless you fully understand rules between preventative medicine and evaluation and management (E&M) coding. Knowing the difference between preventive visits, with its many procedural services and bundled service codes, and E&M visits with its complicated coding and documentation guidelines, is imperative to correct office visit coding. This week on Talk Ten Tuesdays we are joined by Healthcare Coding and Reimbursement Consultant and ...
Jul 21, 2020•32 min•Ep. 423
The use of telehealth has surged during the coronavirus pandemic, with the technology spreading far and fast. Doctors and patients alike must be wondering, 'is the beginning of a whole new kind of doctor–patient relationship'? One that will transform health care systems? With the uptick in the use of telehealth the Office of Inspector General (OIG) and Center of Medicare and Medicaid Services (CMS) has added Telehealth to the list of audits due to data analysis and non-compliance. Joining us thi...
Jul 14, 2020•29 min•Ep. 422
Outpatient clinical documentation improvement (CDI) programs have moved into the mainstream, as hospitals and healthcare systems continue to embrace consulting companies’ push into the outpatient arena. As the CDI profession matures and the market for CDI consulting becomes more competitive and less lucrative, these companies have identified a new long-term revenue stream associated with consulting engagements, in addition to software. Joining us this week onTalk Ten Tuesdays will be Glenn Kraus...
Jun 30, 2020•30 min•Ep. 421
As the country begins to reopen, it is essential to have clear and accurate data for leadership to make informed decisions during the phased reopening. The U.S. Department of Health and Human Services (HHS) has recently announced guidelines for additional data to be reported to HHS by laboratories along with COVID-19 test results. These guidelines allow for standardization of reporting and ensure comprehensive and nearly real-time data for COVID-19 decision-makers. During this episode of Talk Te...
Jun 23, 2020•29 min•Ep. 420
umbersome yet secure, your PPE is firmly in place as you shadow Dr. David Jury, similarly attired, as he makes his rounds in the ICU, explaining to you the handoff from his overnight telemedicine colleague… Join for a remarkable, albeit virtual, journey into an ICU unit at the famed Cleveland Clinic, as our Talk Ten Tuesdays special guest Dr. David Jury describes his role as an anesthesiologist and critical care physician dealing with COVID-19 patients. “I love what I do,” Jury wrote in a recent...
Jun 16, 2020•30 min•Ep. 419
When your team comes to the negotiating table with commercial payers this year, they’ll be doing so in the new normal: the coronavirus pandemic. Whether contract negotiations come during or toward the end of this country’s most devasting healthcare crisis in a century, this will be a whole new ballgame. Having wreaked havoc on institutions, policies, and procedures, the lingering effect of the pandemic is expected to bring to the forefront unprecedented financial and public health challenges for...
Jun 09, 2020•29 min•Ep. 418
“In my opinion, as a physician and an ex-physician advisor, I can categorically assure you that it would irritate a provider to get queried to confirm a diagnosis they had already made clinically and documented in a codable format,” writes Erica Remer, MD, Talk Ten Tuesdays program host-turned-correspondent, who will be reporting our lead story during this edition of Talk Ten Tuesdays. “I agree with developing facility-specific coding guidelines, but they should be sensible and reasonable,” Reme...
Jun 02, 2020•29 min•Ep. 417
If physician documentation is missing or does not support the level or evaluation and management (E&M) service billed, surgery performed, or durable medical equipment (DME) issued, an addendum should be requested from the physician. A valid addendum must be received before the claim is submitted. Reporting our lead story during this of Talk Ten Tuesdays will be Terry Fletcher, nationally recognized professional physician coder and auditor. Fletcher reports on the need to know how to correctl...
May 19, 2020•30 min•Ep. 416
Waivers, modifiers, lab tests, multiple diagnosis codes: they constitute layer upon layer of intricacies that could get in way of your reimbursement. That is why accurate COVID-19 coding cannot be overlooked when ensuring appropriate compensation and safeguarding claims against third-party payer audits. Reporting our lead story during this edition of Talk Ten Tuesdays is Susan Gatehouse, founder and CEO of Axea Solutions. The live broadcast will also feature these other segments: COVID-19 Telehe...
May 12, 2020•34 min•Ep. 415
It’s coming. And it could soon be spreading, as is the coronavirus: healthcare fraud and abuse. After all, there’s lots of money involved, at a time when waivers have been issued and rules relaxed, as the nation’s healthcare system focuses on fending off COVID-19. These changes include FaceTime, Skype, and telephone calls being reimbursed as telehealth and telemedicine services: a factor that can lead to fraud and abuse on scale not likely to be seen ever before the deadly virus upended processe...
May 05, 2020•30 min•Ep. 414
Most of us are working from home now. That’s quite amazing. During the month of July 2019, an estimated total of 4.7 million folks telecommuted, either full or part-time. Fast forward to the national stay-at-home edict, and now, according to Global Workplace Analytics, those working at home could possibly number 75 million. So, what new privacy concerns are emerging, with healthcare professionals now working remotely as a result of the lockdown? How is it possible to stay alert, fit, and nimble,...
Apr 28, 2020•38 min•Ep. 413
The costs of managing prolonged ICU stays for COVID-19 patients, combined with lost revenue from decreased ambulatory visits and the cancellation of elective procedures, will have health systems and provider groups emerging from the ongoing pandemic with significant financial challenges. It will be more important than ever to ensure that clinical documentation reflects the true complexity of care being delivered. Reporting our lead story during this edition of Talk Ten Tuesdays will be Matt Lamb...
Apr 21, 2020•30 min•Ep. 412
Medical decision-making (MDM) and medical necessity are not the same thing. MDM specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. But which determines how you get reimbursed, when many healthcare professionals use these terms interchangeably? The live broadcast will also feature these other segments: Mental Health Report: H. Steven Moffic, MD, one...
Apr 14, 2020•30 min•Ep. 411
The confluence of the global COVID-19 pandemic and the World Health Organization (WHO) designation of April 7 as World Health Day is fast approaching. Nonetheless, the organization is asking its global partners to take the time to recognize the work of nurses and midwives, acknowledging the “critical role they play in keeping the world healthy,” marking the raison d'être for the International Year of the Nurse and Midwife. Reporting our lead story during this edition of Talk Ten Tuesdays Lorrain...
Apr 07, 2020•28 min•Ep. 410
Eighty percent of what influences a person’s health is related to non-medical issues such as food, housing, upbringing, social support, and income. These socioeconomic and psychosocial circumstances are known as the social determinants of health (SdoH). With the goal of allowing physicians more time with their patients, the American Medical Association (AMA) has made significant revisions to the Office and Other Outpatient Services New and Established Evaluation & Management (E&M) catego...
Mar 31, 2020•30 min•Ep. 409
What are care management services, and are you capturing revenue associated with them? Transitional care management (TCM), chronic care management (CCM), advance care planning (ACP), and behavioral health integration are among services you may already be providing for your patients. Good news: you can be paid for those services, as you’ll discover during the next live edition of Talk Ten Tuesdays when nationally-recognized professional physician coder and auditor Terry Fletcher reports our lead ...
Mar 25, 2020•30 min•Ep. 408
Will there be a code for EVALI? Or the use of e-cigarettes? Or one for the deadly coronavirus that the World Health Organization has now declared as a pandemic? In light of the coronavirus outbreak, the ICD-10 Coordination and Maintenance Committee (C&M) meeting will be online only and convene Tuesday, March 17. The virtual meeting brings together representatives from the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention's (CDC) National Center ...
Mar 17, 2020•30 min•Ep. 407
There are HIPAA privacy rights that reach farther than those of the average patient. And there are privacy provisions in the Patient Protection and Affordable Care Act (PPACA) that prohibit discrimination against this population of patients. But do these prevent discrimination against transgender patients? During this edition of Talk Ten Tuesdays, we asked nationally-recognized professional physician coder and auditor Terry Fletcher to report on the insurance policies from state to state on what...
Mar 10, 2020•29 min•Ep. 406
With more cases of the novel coronavirus (COVID-19) being reported in countries outside of China, where the deadly virus has claimed the lives of a reported 2,771, world health leaders are preparing for a global pandemic that will provide a tsunami of health information for use by governments, world health agencies, and researchers, to hopefully control the future spread of the disease, develop vaccines, and share new learning to prevent future outbreaks. That’s a good thing. But what about the ...
Mar 03, 2020•29 min•Ep. 405
The Trump Administration has grand plans to make healthcare prices more transparent, hoping a little bit of light will help lower the high costs of U.S. healthcare. In new regulations, the administration is requiring hospitals to disclose, for the first time, the prices they negotiated with health insurers for a wide range of services, as well as the prices they charge patients who are paying with their own money. But is it going to make any difference? We ask nationally-recognized professional ...
Feb 25, 2020•30 min•Ep. 404
Dr. Nichols, who is authoring an exclusive four-part series on healthcare data for ICD10monitor, reports on the crucial search for reliable health information, noting that without it, all stakeholders are at significant financial and/or personal health risks. Dr. Moffic, one of America’s foremost psychiatrists, reports on the intriguing subject of solastalgia – the rising world temperature, and its impact on mental health. Dr. Moffic is writing an exclusive series on the topic for ICD10monitor, ...
Feb 18, 2020•30 min•Ep. 403
While facilities and practices are concentrating on making critical changes in 2020 and 2021, it is important not to lose focus on the basics of correct coding. CPT® and ICD-10-CM coding errors can cost healthcare providers millions of dollars in lost revenue, but also, those errors can trigger compliance issues that could lead to audits. Reporting our lead story during this edition of Talk Ten Tuesdays is a nationally recognized professional physician coder and auditor Terry Fletcher. The podca...
Feb 11, 2020•33 min•Ep. 402
The release of the fiscal year (FY) 2020 Official Guidelines for Coding and Reporting (OCG) has resulted in confusion and apprehension surrounding the intent of the new guideline related to the new ICD-10-CM codes for pressure-induced deep-tissue damage or deep-tissue pressure injury (L89.-6). The ambiguity stems from what appears to be conflicting advice found within the coding guidelines (I.C.12.a) regarding pressure ulcer stage codes, as you’ll learn when Lisa Baris, Director of Health Inform...
Feb 04, 2020•30 min•Ep. 401
With prior authorization (PA) posing a significant pain point for healthcare providers and a major headache for most practices, Talk Ten Tuesdays asked Terry Fletcher to report on this troubling issue, especially in light of the WEDI survey results posted this week, revealing that 84 percent of providers reported that the number of medical services requiring PA has increased. The PA process, heavily dependent on manual tasks, has grown to become one of the biggest frustrations for physicians in ...
Jan 28, 2020•30 min•Ep. 400
