Clinical documentation integrity (CDI) programs can have a broad impact in outpatient settings. One key area for outpatient CDI to consider is denials reduction, which begins with understanding what’s contributing to denial risk. Denial reduction is really about denial prevention. It’s about analyzing denials by category, by payer, and by reason to uncover trends for high-volume or high-dollar denials, then using that discovery to provide education about clinical documentation issues or gaps. In...
Dec 07, 2021•59 min•Season 11Ep. 488
Are you facing a problem with your physcians? They find themselves with patients who have not just one but two or more chronic conditions that need managing? Not just for in-person encounters, but from an ongoing, non-face-to-face perspective? Many practices have this patient population, but are not capturing care management services correctly, or at all, for work that is already being done. It’s a huge problem with potentially serious financial impacts. But the answer is close at hand. Listen t...
Nov 30, 2021•29 min
Like the inevitable approach of a slow-moving freight train, ICD-11 is on the horizon, heading this way. It’s coming. That’s why we asked Margaret Skurka to join us for the next upcoming edition of Talk-Ten-Tuesdays: to give you an exclusive update on the new code set for America’s health system. Skurka, a member of the National Committee of Vital Health Statistics (NCVHS), participated in describing for the Honorable Xavier Becerra, Secretary of the U.S. Department of Health and Human Services ...
Nov 23, 2021•32 min•Ep. 486
The Omnibus COVID-19 Health Care Staff Vaccination Mandates are out! What entities are included under the regulations, and which are excluded? Facilities and physician practices have been doing everything they can to get staff and providers vaccinated, in fear of losing their provider status with Medicare and their funds being interrupted. But what organizations really must abide by these requirements under the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs)...
Nov 16, 2021•30 min•Season 11Ep. 485
Is the emergency department (ED) an outpatient CDI priority for your organization? The emergency department is the main source of admissions to a hospital – and the first location patients typically receive care. What should you consider when determining how an outpatient CDI program could support quality patient care, proper payment, and complete and accurate data? During the next live edition of Talk Ten Tuesdays, outpatient CDI expert Colleen Deighan will return with another installment in he...
Nov 09, 2021•29 min•Season 11Ep. 484
What can a medical assistant do – and not do? Medical assistants have a narrow list of tasks they can perform for patients or for a doctor in a doctor's office. It's often difficult to know what's allowed, because there are not strong laws or regulations in place regarding medical assistants. Since no one really “regulates” them, and they are frighteningly under-monitored by any sort of government agency, what rules should they follow? In the next live edition of Talk Ten Tuesdays, Terry Fletche...
Nov 02, 2021•31 min•Ep. 483
Outpatient CDI expert Colleen Deighan will return to the next edition of Talk Ten Tuesdays to continue her popular series on a subject that continues to generate listener interest and questions. Deighan will also conduct a listener’s survey during the weekly Internet radio broadcast. When healthcare organizations are considering, planning, or beginning efforts directed toward documentation integrity in the outpatient setting, Hierarchical Condition Categories (HCCs) are a key focus. Deighan will...
Oct 26, 2021•33 min•Ep. 482
We’re taking AIM at reducing maternal morbidity and mortality during an exclusive four-part series on ICD10monitor and Talk Ten Tuesdays. The series will be led by senior healthcare consultant Kristi Pollard, Director of Coding Quality and Education for the Haugen Consulting Group. During her series, Kristi will discuss how coded data is being used by the Alliance for Innovation on Maternal Health (AIM) to improve maternal outcomes. The live broadcast will also feature these other segments: Spec...
Oct 19, 2021•31 min•Season 11Ep. 481
Outpatient CDI programs can have real impact with risk adjustment and Hierarchical Condition Categories (HCCs). An important component of the HCC risk adjustment model is accurate and appropriate HCC capture, representing a patient’s disease burden year over year. HCCs reflect hierarchies within related disease categories. A patient can have multiple HCC categories assigned, and each category, along with patient demographics, is factored into the patient’s overall risk adjustment factor (RAF) sc...
Oct 12, 2021•56 min•Season 11Ep. 480
The COVID-19 pandemic rages on, exposing huge gaps in America’s vulnerable healthcare system, posing life-or-death questions that tear at our collective subconsciousness. There’s also the constant drumbeat of headline news: vaccination mandates versus personal freedom, for example. Are two shots sufficient, or are three better? Should young children be vaccinated or not? With staff shortages and the rationing of care, who gets an inpatient bed and who doesn’t? Today, as never before, mental stre...
Oct 05, 2021•30 min•Season 11Ep. 479
Physician engagement, query productivity, and revenue integrity are some but not all of the activities that encompass today’s outpatient clinical documentation integrity (OP CDI) arena, which continues to gain traction among America’s hospitals and health systems. During an exclusive broadcast report, CDI expert Colleen Deighan will unveil a Talk Ten Tuesdays listener’s survey on this topic, in which listeners are encouraged to participate. Delving into the survey responses, Colleen will join us...
Sep 28, 2021•57 min•Ep. 478
The National Institutes of Health (NIH) is awarding $470 million to New York University to perform a national study on “tens of thousands of people, to research the long-term effects of COVID-19.” One such individual who might be included in the study will be the special guest during the next live edition of Talk-Ten-Tuesdays: Deborah Grider, longtime ICD10monitor national correspondent and senior healthcare consultant for Karen Zupko & Associates. Grider will return to the broadcast with an...
Sep 21, 2021•31 min•Season 11Ep. 477
The COVID-19 pandemic continues to rage throughout the U.S., fueled by the Delta variant that is driving a new surge of infections of the deadly coronavirus – all this amid growing antagonism about mask mandates and vaccine hesitancy. The U.S. death toll now stands at more than 650,000, with projections indicating more than 750,000 deaths being likely by Dec. 1. In fact, Idaho, reported to have the nation’s lowest vaccination rate – only 45 percent of its population has received at least one dos...
Sep 14, 2021•31 min•Season 11Ep. 476
Questions and concerns about the recent and significant updates to Patient Safety Indicators (PSI) by the Agency for Healthcare Research and Quality (AHRQ) has prompted the return of Dr. James Kennedy, a subject matter expert on PSIs, to the next live edition of Talk Ten Tuesdays. The live broadcast will also feature these other segments: Coding Report: Senior healthcare consultant and well-known national coding and health information management (HIM) leader Gloryanne Bryant will substitute for ...
Aug 31, 2021•30 min•Season 11Ep. 475
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) – which factor greatly into provider success with the Medicare Inpatient Quality Reporting, Leapfrog, and Maryland quality initiatives – were recently significantly updated for the 2021 fiscal year (FY). During the next live edition of Talk Ten Tuesdays, you’ll learn why PSI 8, Hospital-acquired hip fracture; PSI 11, Postoperative respiratory failure; and PSI 14, Wound dehiscence rates are likely to increase a...
Aug 25, 2021•32 min•Season 11Ep. 474
The rapidly expanding surge of COVID-19 infections is triggering a renewed look at the impact the virus is having on long-haulers. The pressing challenge is to understand the findings on the sequelae after recovery from COVID-19 – and what variations are expected to evolve. Meanwhile, research reveals that about 14 percent of adults who had been infected with the virus developed at least one new clinical sequela requiring medical attention after recovery from COVID-19, although many specifics ha...
Aug 17, 2021•29 min•Ep. 473
Let’s start with a basic question: are you affiliated with a Health Insurance Portability and Accountability Act (HIPAA) covered entity? If so, remember, such entities must comply with standards for electronic transactions, not just privacy. When you’re asked about your vaccine status, do you claim a HIPAA violation? Is your vaccine status only your business, and no one else’s? If not, whose business is it, really? Is it your employers’ business, or that of the airline or cruise ship company thr...
Aug 10, 2021•30 min•Ep. 472
Surgery doesn't have to be complicated; it shouldn't automatically translate into a misadventure. Recent American Hospital Association (AHA) advice has the potential to result in artificially elevated complication rates for surgery, however, jeopardizing your safety and performance profiles. Clinical accuracy of diagnoses is king, even in the operating room. Reporting on this developing story during the next live edition of Talk Ten Tuesdays will be senior healthcare executive Allen Frady, who w...
Aug 03, 2021•30 min•Ep. 471
"Where did all the money go?" It’s a valid question. Join us for the next live edition of Talk Ten Tuesdays, when nationally-recognized professional coder, educator, and auditor Terry Fletcher will provide an answer by discussing a topic not addressed often enough: physician under-coding. The bad habit leads to not getting paid for services provided. Multiply those issues by 20 to 30 patient encounters daily, and it’s little wonder that physicians are missing a ton of money – important and well-...
Jul 27, 2021•31 min•Ep. 470
The American Health Information Management Association (AHIMA) has just released a new practice brief focused on prospective clinical documentation integrity reviews and query alerts. Being revealed for the first time during the next edition of Talk Ten Tuesdays, the practice brief was developed by AHIMA through a workgroup of clinical documentation integrity (CDI) industry experts. The free practice brief explores the need for prospective reviews and the impact they have on the CDI industry. Th...
Jul 20, 2021•28 min•Ep. 469
Lawmakers are lining up to decide what Medicare will pay for after the COVID-19 public health emergency (PHE) is over – and they are looking confident that they have the votes to include it in a must-pass piece of legislation this year. Congress also seems to be on board with a plan to allow millions of Medicare patients to continue to video-chat with their physicians once the PHE is over. The Medicare advisory committee, MedPAC, has recommended a cautious approach, however, that would temporari...
Jul 13, 2021•31 min•Ep. 468
“Querying is the lifeline of clinical documentation integrity (CDI) professionals and many coding professionals,” wrote Cheryl Ericson in a recent edition of ICD10monitor. And yet the query process can be a time-consuming and sometimes arduous activity that often contributes to an inefficient CDI workflow. One of the biggest hindrances to an efficient query process appears to hinge on misinformation regarding what is considered a leading or non-compliant query, specifically as it pertains to the...
Jun 29, 2021•30 min•Ep. 467
Are you monitoring the 2021 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan? The watchdog agency is watching you. They’re auditing claims for evaluation and management (E&M) services performed on the same day as minor surgical procedures that have been documented with Modifier 25. The backstory: in 2019, about 56 percent of dermatologists' claims with an E&M service also included minor surgical procedures (such as lesion removals, destructio...
Jun 22, 2021•31 min•Ep. 466
The ongoing quest to improve quality includes the auditing of low-value services. During the next episode of Talk Ten Tuesdays, Susan Gatehouse, founder and CEO for Axea Solutions, will report on areas to reduce wasteful spending on services with little to no clinical benefit – all in the name of improving quality of care. According to most industry definitions, low-value care involves those services that are medically unnecessary and provide no health benefits to patients. The live broadcast wi...
Jun 15, 2021•33 min•Ep. 465
Outsourcing versus offshoring – a debate long representing a tacit acknowledgment of how many U.S. facilities and physician practices approach coding and billing – has resurfaced as providers grapple with which to choose as the customary way to submit medical claims. Although once considered verboten, today this is more or less becoming mainstream, or the "new normal," with globalization on the horizon. But should your facility consider outsourcing medical coding and billing – and if you do, how...
Jun 08, 2021•31 min•Ep. 464
The American Medical Association (AMA) CPT® Errata and Technical Corrections have clarified some grey areas found in the 2021 Evaluation and Management (E&M) Guidelines. But did the updates really help coders and physicians in better understanding how to apply the latest corrections? Apparently, there’s still confusion, according to Terry Fletcher, a nationally recognized physician auditor and coder. Fletcher will return to the Talk Ten Tuesdays weekly broadcast to offer some working example...
May 25, 2021•31 min•Ep. 463
Healthcare providers nationwide are scanning the horizon for the first signs of ICD-11, which is slowly making its presence seen and felt. However far in the future you might speculate the transition to ICD-11 to be, the reality is that preparation and planning will take time, and understanding the new concepts being introduced is a key starting point. And that will be where we start during the next live edition of Talk-Ten-Tuesdays; join Chuck Buck and Dr. Erica Remer when they welcome the retu...
May 18, 2021•27 min
When the Centers for Medicare & Medicaid Services (CMS) began down the path of change that the American Medical Association (AMA) delivered in 2021 for the purpose of administrative burden relief, it was expected that there would be some initial investments of time necessary to create models of efficiency in a new era of documentation. But most providers have chosen to avoid it. The totality is the patient story. And hasn’t that been the problem since the inception of templates, and one of t...
May 11, 2021•29 min•Ep. 461
It’s vitally important to remember that updates to the American Medical Association (AMA) CPT® code book might not be there when you need them. But since January of this year, the AMA has been receiving provider feedback: essential information that now been incorporated in the AMA 2021 CPT® Errata and Technical Corrections. Navigating these changes during the next edition of Talk Ten Tuesdays will be nationally recognized physician auditor and coder Terry Fletcher, who will report on significant...
May 04, 2021•29 min•Ep. 460
There’s a new segment of the healthcare population that represents yet another opportunity for health information management (HIM) professionals to leverage existing staff and processes to improve their organization’s bottom line. That new segment: physicians employed by healthcare systems. During the next live edition of Talk-Ten-Tuesdays, nationally acclaimed HIM professional Rose T. Dunn, two-term president of the American Health Information Management Association (AHIMA) and chief operations...
Apr 27, 2021•31 min•Ep. 459
