A key (and occasionally overlooked) role of the physician advisor is advocacy: advocacy for physician partners, advocacy for quality patient outcomes, and advocacy for clinical medicine represented on committees, in board rooms, and to agencies defining national standards. During the next live edition of Talk Ten Tuesdays, Dr. Drew Updike, medical director of coding at UCHealth, and Dr. Debra Anoff, senior medical director of clinical documentation improvement (CDI) for UCHealth, will offer a bl...
Apr 20, 2021•32 min•Ep. 458
Every day, in facilities ranging from small rural hospitals to large academic teaching facilities and health systems, these dedicated professionals are working to keep patient health information data accurate, secure, and most importantly, personal. Because when it’s personal, it’s relevant. As part of our recognition of the importance of HIPs, please listen to HIP Voices, a podcast during which you’ll hear the stories of three dedicated professionals: Laurie Peters, Global privacy officer at Or...
Apr 15, 2021•12 min
ICD10monitor and Talk Ten Tuesdays will continue their reporting on the advent of ICD-11 – particularly during April, when attention turns to the World Health Organization (WHO). A key question that needs answering: where does the United States fall among the countries that are either preparing or even implementing the new update for the standard code set? For a global perspective on ICD-11 and the nation’s position on the new code set, Margaret Skurka, a member of the International Federation o...
Apr 14, 2021•32 min•Ep. 457
The World Health Organization (WHO) gave us the International Classification of Diseases (ICD), including several updates over the years, more recently versions 9 and 10. And now on the horizon is version 11. Thus, it is only fitting that Talk Ten Tuesdays would focus on the global accomplishments of the WHO this week, with the lead story for this upcoming edition focusing on the looming implementation of the new update for the standard code set. Leading off the reporting will be the broadcast’s...
Apr 06, 2021•32 min•Ep. 456
Implementation of the 21st Century Cures Act is set for Monday, April 5. In a nutshell, the legislation directs providers to cease all efforts of information blocking with respect to their electronic health records (EHRs), and to encourage and promote interoperability, allowing for communication and cooperation with third-party application program interfaces. With respect to portions of clinical notes, there appear to be certain exceptions where physicians can block access, including psychothera...
Mar 30, 2021•30 min•Ep. 455
The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) have announced a proposal for biannual ICD-10-CM and PCS updates. The impact on business processes would be far-reaching – much of it good, and some possibly not so good, according to Susan Gatehouse, who will report this development as the lead story during the next live edition of Talk Ten Tuesdays. Gatehouse, the founder and CEO for Axea ...
Mar 23, 2021•29 min•Ep. 454
To improve patient care and create transparency, Medicare mandated a pay-for-quality reporting program for hospital outpatient services in 2009. The related measures can impact hospital payment if not met, thus creating financial incentives for hospitals to report them. The measures are intended to evaluate the regularity of outpatient treatments known to provide the best results for most patients with a particular condition. During the next three broadcasts of Talk-Ten-Tuesdays, listeners will ...
Mar 16, 2021•30 min•Ep. 453
Whether you work for a full-scale enterprise or a smaller healthcare facility, the importance of revenue integrity programs is gaining increased importance, especially in the light of renewed auditing activities anticipated under the Biden Administration. Beyond ensuring accurate billing and collection, revenue integrity should strengthen reimbursement performance and provide sound financial practices, according to Susan Gatehouse, founder and CEO for Axea Solutions, who will report on our lead ...
Mar 09, 2021•28 min•Ep. 452
Will there be an ICD-10 code for post-traumatic visual disturbance? Or for an encounter for PPD test reading and medication review? Or prolonged grief disorder? In light of COVID-19, the ICD-10 Coordination and Maintenance Committee (C&M) meeting will be online-only, as was the case last spring, at the outset of the pandemic. This year, the two-day meeting begins next Tuesday, March 9, continuing through March 10, bringing together representatives from the Centers for Medicare & Medicaid...
Mar 02, 2021•26 min•Ep. 451
Infection rates from the coronavirus are declining. Vaccination rates are increasing. And while that’s good news, word on the ground is anything but good. Vaccination distribution in the U.S. has been, by most accounts, uneven, with reports of supplies not keeping up with demand in many states. And this week, a spate of bad weather, particularly in Texas and states across the Southeast, is hampering vaccination efforts – and in some cases, cancelling mass inoculation events. During the next live...
Feb 23, 2021•32 min•Ep. 450
They’re standing in long lines, often in the early morning darkness and in the cold, waiting for access to community vaccination centers all across the country. According to the Centers for Disease Control and Prevention (CDC), more than 1 million doses are being administered daily to grateful recipients. Yet there’s still the disturbing trend of vaccine hesitancy . Driven by misinformation, lack of trust, and concerns about safety and efficacy, vaccine hesitancy is considered to be one of the t...
Feb 16, 2021•31 min•Ep. 449
The Centers for Disease Control and Prevention (CDC) is forecasting that there will be more than 500,000 deaths from the coronavirus in the U.S. by the third week of February. In the meantime, the U.S. vaccine rollout fell short of federal projections, according to Bloomberg News, which noted that the initial round of shots, delivered through early January, was distributed through hospitals. Then there’s the disturbing trend of vaccine hesitancy . Driven by misinformation, lack of trust, and con...
Feb 09, 2021•32 min•Ep. 448
The Centers for Disease Control and Prevention (CDC) is forecasting that there will be more than 500,000 deaths from the coronavirus in the U.S. by the third week of February. In the meantime, there has been a flurry of activity by major pharmaceutical companies to work together to help meet the huge demand for vaccines, all against the backdrop of an emerging trend: vaccine hesitancy . Driven by misinformation, lack of trust, and concerns about safety and efficacy, vaccine hesitancy is consider...
Feb 02, 2021•29 min•Ep. 447
There has long been a focus on improving documentation for the purpose of maximizing the capture of complications and morbidities and major complications and morbidities (CCs and MCCs). As value-based purchasing is becoming more widely adopted, the importance of improving documentation is becoming more relevant. Case in point: the importance of coagulopathy documentation and its impact on perioperative hemorrhage and hematoma, a patient safety indictor (PSI-9). Reporting our lead story during th...
Jan 26, 2021•29 min•Ep. 446
The U.S. death toll from the coronavirus is approaching the number of Americans killed in World War II, and as America is experiencing another surge of infections, the once-unthinkable subject of rationing care is now being debated. But how is care to be rationed? Is there a uniform guide for triaging care, as the availability of all beds, ICU beds, ventilators, and other hospital equipment is weighed, based on the acuity of each patient? As John Zelem, MD wrote recently for RACmonitor, “we have...
Jan 19, 2021•29 min•Ep. 445
The Centers for Medicare & Medicaid Services (CMS) 2021 Final Rule and 2021 Medicare Physician Fee Schedule (MPFS) are effective Jan. 1, 2021, and both affect reimbursement. But in a rare move, CMS increased the conversion factor (CF) in the MPFS twice in one week as a result of the COVID-19 relief bill, which added a hike of 3.75 percent. For an update on the major CMS changes for 2021 that will affect your reimbursement under the Part B Physician Fee Schedule, tune in to the next live edit...
Jan 12, 2021•29 min•Ep. 444
Out in the West Texas “town” of El Paso, a number of COVID-19 patients are being treated with a new monoclonal antibody infusion called bamlanivimab. Now in the second week of the operation being conducted in the El Paso Convention Center’s makeshift hospital, Dr. Edward Michelson, Chair of the Department of Emergency Medicine at Texas Tech University Health Sciences Center, reports that while treatments are underway, there hasn’t been enough time to gather data on the effects and outcomes. Dr. ...
Dec 08, 2020•33 min•Ep. 443
There’s a recently added CPT® code for personal protective equipment (PPE). But there’s a corresponding catch: who pays and who doesn’t, and what’s the best practice for handling the new normal in physician practices? Could the new code, 99072, although a payable service by Medicare, as well as commercial payers, wind up being a patient’s out-of-pocket expense? Reporting our lead story during the next live edition of Talk Ten Tuesdays will be nationally recognized professional coder and auditor ...
Dec 01, 2020•30 min•Ep. 442
Thanksgiving, the flu season, and a dramatic surge of the COVID-19 pandemic are converging at a time when the nation’s coronavirus death toll has reportedly exceeded 250,000, with more than 11 million confirmed cases. With soaring infection rates come more testing, as well as more hospitalizations and deaths. A focus on COVID-19 testing will come into sharp relief as Talk Ten Tuesdays concludes its exclusive three-part series on false-positive tests. During this episode, co-host Erica Remer, MD ...
Nov 24, 2020•31 min•Ep. 441
The global coronavirus pandemic is worsening quickly, and at a time when winter is bearing down, forcing more of us to remain inside. In fact, health experts are predicting that confirmed daily cases of COVID-19 will climb above 200,000 nationally. With soaring infection rates come more testing, as well as more hospitalizations and deaths. A focus on COVID-19 testing will come into sharp relief as Talk Ten Tuesdays continues with the second portion of its three-part series on false-positive test...
Nov 17, 2020•29 min•Ep. 440
As the nation is experiencing a dramatic surge in confirmed cases of COVID-19, the terms “false negative” and “false positive” accompany not only medical records, but also news media dispatches. The public health establishment and the medical world have generally treated positive results of PCR-based tests for the virus that causes COVID-19 as if they are infallible. The evidence shows that this may not be true, and there are real-life implications of false positives – yet to date, there has bee...
Nov 10, 2020•30 min•Ep. 439
We are all participants in one of the most tumultuous times in the 21st century. A global pandemic rages throughout the United States and Europe, the consequences of which are tangible, but not yet fully quantified. A divisive political environment, exacerbated by 24/7 news and social media, has intensified our feelings about ourselves, our colleagues, neighbors, and family members. Stress and tension abound, of which the consequences are many, with depression and anxiety also taking a physical ...
Nov 03, 2020•30 min•Ep. 438
Amid the global COVID-19 pandemic, the 2020 presidential campaign, coding updates, and a tangle of regulatory waivers, it’s important to not to lose sight of the fact that ICD-11 for the United States is on the horizon. That’s why we asked Margaret Skurka, a voting member of the National Committee on Vital and Health Statistics (NCVHS) in Washington, D.C., who also sits at the table of the World Health Organization’s (WHO’s) Education and Implementation Committee, to report on the latest ICD-11 ...
Oct 27, 2020•34 min•Ep. 437
In the deadly throes of a global pandemic, Americans are struggling as they adjust to a confusing new normal. Halloween this year will portend an actual frightening threat. And America’s traditional Thanksgiving dinner will have an unwanted guest: COVID-19, the elephant in the room. The coronavirus continues to dominate headlines, family dinner conversations, political debates, congressional hearings, and the news media. During this edition of Talk Ten Tuesdays, providing a physician’s perspecti...
Oct 20, 2020•27 min•Ep. 436
Once a frequent flyer with all the attendant privileges, senior healthcare consultant Deborah Grider was abruptly grounded when COVID-19 curtailed her coast-to-coast consulting. She first reported on her sequela from the coronavirus infection, the disease that causes COVID-19, for Talk Ten Tuesdays listeners in July. Now, she will return to the long-running broadcast to report on several other conditions that have arisen. About one in six people who have survived COVID-19 are expected to have lo...
Oct 13, 2020•35 min•Ep. 435
Given the importance of medical review activities relative to the program integrity efforts of the Centers for Medicare & Medicaid Services (CMS), and regardless of the status of the current federal public health emergency (PHE), providers can expect imminent pre- and post-payment reviews, plus audits by Supplemental Medical Review Contractors (SMRCs) and the Recovery Audit Contractors (RACs). Reporting our lead story during this edition of Talk Ten Tuesdays will be nationally recognized pro...
Oct 06, 2020•32 min•Ep. 434
The Centers for Medicare & Medicaid Services (CMS) has ordered Medicare Advantage Organization (MAO), -hired subcontractors, to stop issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized. Reporting our lead story during this edition of Talk Ten Tuesdays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. Dr. Hu was one of several healthcare executives who convinced CMS to issue a recent...
Sep 29, 2020•30 min•Ep. 433
Battle lines in a budding court battle could be drawn soon. A federal appeals court has reversed the decision of a lower court and upheld the action by the U.S. Department of Health and Human Services (HHS) to pay formerly grandfathered off-campus outpatient departments run by hospitals at the same, lower rate of physician clinics. Experts believe that could mean a potential loss of $800 million to these already struggling hospitals, the finances of which have been especially hit hard during the...
Sep 22, 2020•31 min•Ep. 432
COVID-19 is disrupting the stability of food, shelter, and sleep. Stress levels are unthinkable. The continuing pandemic, along with unemployment, racial injustice, and social isolation, is raising anxiety and depression to high levels as well. Moreover, it’s been reported that ongoing stress can decrease the body’s lymphocyte levels, making infection more likely. This cycle is evident among COVID patients. Reporting on this untenable situation during the next edition of Talk Ten Tuesdays will b...
Sep 15, 2020•28 min•Ep. 431
The long-awaited and highly anticipated Inpatient Prospective Payment System Final rule was released late Tuesday afternoon, September 2nd. Due to the rule being published Tuesday, Sept. 2, you and your team have precious little time to prepare for these changes since the IPPS becomes effective Oct. 1, 2020. Joining us today for this special Talk Ten Tuesdays is Stanley Nachimson is a former CMS career professional and is the founder of Nachimson Advisors, LLC; and Laurie Johnson, senior healthc...
Sep 10, 2020•12 min
