At the intersection of ICD-10-CM social determinants of health (SDoH) codes and the Centers for Medicare & Medicaid Services (CMS) Star Rating Quality Measures, one will find a wide array of socio-economic factors and competing issues, all of which carry the potential to profoundly affect healthcare outcomes and ratings. During the next live edition of Talk Ten Tuesdays, listeners will enjoy the benefits of learning new strategies to leverage these codes for enhanced quality scores and healt...
Jul 11, 2023•30 min•Season 13Ep. 560
Major updates regarding progress on the imminent ICD-11 code set were made during the recent meeting of the National Committee of Vital Health Statistics (NCVHS), including a request for information on the enigmatic code set, yet to be adopted by the U.S. Stanley Nachimson, longtime editorial contributor to ICD10monitor and former career professional at the Centers for Medicare & Medicaid Services (CMS), now an IT consultant, monitored the recent meeting and will report other NCVHS actions, ...
Jun 27, 2023•29 min•Season 13Ep. 559
What possible factors might trigger an audit or result in money being left on the table? During the live edition of Talk Ten Tuesdays, Gloryanne Bryant, an independent health information management (HIM) consultant, will report on highlights of the 2023 Second Quarter ICD-10-CM/PCS Coding Clinic from the American Hospital Association (AHA) for the second quarter of 2023. Gloryanne — a 40+ year veteran Health Information Management (HIM) professional and past president of the California Health In...
Jun 20, 2023•29 min•Season 13Ep. 558
Delays in billing can cost healthcare providers billions of dollars annually. Join us during the next live edition of Talk Ten Tuesdays, when the broadcast’s special guest, Susie Vestevich, COO of TiaTech USA, will discuss potential solutions that may be implemented to combat this dire issue. Talk Ten Tuesdays will also feature these outstanding segments and thought leaders: Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, will report the latest codin...
Jun 13, 2023•27 min•Season 13Ep. 557
A recurring conflict continues to plague America’s patchwork system of healthcare delivery. How often, muses Mary Beth Pace, vice president of care management at Trinity Health, is the acute-care environment at odds with payers on the issue of inpatient versus outpatient care? “Is there a better way?” she asks rhetorically. “What if we partnered together?” During the next live edition of the popular and long-running Talk Ten Tuesdays Internet broadcast, Pace will serve as special guest, reportin...
Jun 06, 2023•29 min•Season 13Ep. 556
A major focus for many hospitals is understanding the changes that impact Hierarchical Condition Category (HCC) reimbursement methodology – changes made as a result of the Inpatient Prospective Payment System (IPPS) rule that will become effective in 2024. Because it’s important for you to know about these changes, we invited John Pitsikoulis principal at Premier Health, to be the special guest during the next live edition of Talk Ten Tuesdays. Pitsikoulis is expected to report on these recent r...
May 23, 2023•31 min•Season 13Ep. 555
May is Mental Health Awareness Month, and ICD10monitor and Talk Ten Tuesdays are recognizing the major national milestone with a special appearance of world-renowned psychiatrist and author H. Steven Moffic, MD. Every year since 1949, Mental Health Awareness Month has been observed in the U.S. According to Moffic, this year could feature the worst state of America’s mental health since that year. Add to that another level of anxiety among healthcare providers, who are currently grappling with th...
May 16, 2023•29 min•Season 13Ep. 554
Nearly 80 percent of medical practice administrators struggle to keep track of and reconcile patient encounters, as you will learn during the next live edition of Talk Ten Tuesdays, when Susie Vestevich will serve as the special guest. Without adequate tracking, insurance claims aren’t submitted, copays aren’t collected, and patient financial responsibility balances aren’t received. Talk Ten Tuesdays will also feature these outstanding segments and thought leaders: Coding Report: Gloryanne Bryan...
May 09, 2023•29 min•Season 13Ep. 553
The 2024 Inpatient Prospective Payment System (IPPS) proposed rule by the Centers for Medicare & Medicaid Services (CMS), plus half a dozen other proposed payment rules, will all require new codes and fresh new thinking. And that is why ICD10monitor is producing an exclusive national coding update broadcast on Talk Ten Tuesdays. All this and more will be covered during the next live edition of the weekly Internet radio broadcast, which will feature these outstanding segments and thought lead...
May 03, 2023•28 min•Season 13Ep. 552
Continuing previous discussions of cancer screening covered under preventive benefits, the subject will get a second look on the next edition of Talk Ten Tuesdays – when Robin Miller Zweifel joins the broadcast to focus on non-invasive versus invasive procedure options for colorectal cancer screening. Robin is also expected to report on the recent National Correct Coding Initiative (NCCI) procedure-to-procedure edits released in October 2022, noting the sequencing of performance for screening pr...
Apr 25, 2023•32 min•Season 13Ep. 551
Is your facility suffering from revenue loss? If so, you’re not alone. A study by the Journal of the American Medical Informatics Association (JAMIA) found that clinics can experience a 10 to 30 percent decrease in revenue due to coding errors alone, losing up to $125,000 per year. Moreover, the American Medical Association (AMA) estimates that coding errors cost the healthcare industry approximately $36 billion annually in lost revenue, denied claims, and potential fines. During the next live e...
Apr 18, 2023•26 min•Season 13Ep. 550
From starkly arid lands to lush, cosmopolitan foreign capitals, a wide-ranging mix of peoples – some old, some new – were the focus of attention as the World Health Organization (WHO), with characteristic dignity, celebrated 75 years of improving the health of mankind. ICD10monitor (so named for the WHO’s International Classification of Diseases, Version 10) and Talk Ten Tuesdays will mark the occasion with the conclusion of a two-part series recognizing the accomplishments of the WHO, which has...
Apr 11, 2023•32 min•Season 13Ep. 549
Although World Health Day isn’t until April 7, ICD10monitor and Talk Ten Tuesdays will usher in an early recognition of the worldwide event beginning this coming Tuesday, with the start of a two-part series of broadcasts. During the next live edition of Talk Ten Tuesdays, Mary H. Stanfill, ICD10monitor and broadcast ICD-11 correspondent, will have an update on the new coding system, which has been, according to the World Health Organization (WHO), adopted by 35 countries, including the U.S. Howe...
Apr 04, 2023•29 min•Season 13Ep. 548
The end is near: the federal COVID-19 public health emergency (PHE) and national emergency declarations will come to a screeching halt on May 11. And with that, there will be significant effects on healthcare and healthcare providers in the United States. The ends of these declarations could signal a major shift in the response to the pandemic, and may have far-reaching consequences for the industry. One immediate effect could be a decrease in funding for COVID-19-related activities. And that is...
Mar 29, 2023•29 min•Season 13Ep. 547
Are there significant risks of potential fraud and abuse with Medicare Advantage (MA) by plans, vendors, and providers, with an emphasis on ICD-10-CM’s impact on Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) risk adjustment? Evidently, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) believes there are. Recently, Christi A. Grimm, Inspector General, issued a statement in which she addressed the concerns of t...
Mar 21, 2023•32 min•Season 13Ep. 546
It’s all about the money. It’s not only getting paid, but also getting paid the right amount. Little wonder that this is first and foremost on every provider’s mind. Often, though, success or failure lies in the completion and details of medical notes taken. So, what’s the deal with medical notes? Why are notes so important, and why are they difficult for providers to complete? We’ve invited Kevin Lasser, Co-founder and CEO of TiaTech, to be our special guest and to answer those questions during...
Mar 14, 2023•28 min•Season 13Ep. 545
ICD10monitor correspondent Linda Holtzman, founder of Clarity Coding, will return to the Talk Ten Tuesdays (TTT) broadcast this coming Tuesday, March 7 to report on the activities at the Coordination & Maintenance Committee (C&M) meeting taking place from the headquarters of the Centers for Medicare & Medicaid Services (CMS). Holtzman, a longtime C&M observer, will bring her knowledge and expertise to her reporting of this important event – an essential meeting for coders and cli...
Mar 07, 2023•30 min•Season 13Ep. 544
We will conclude our month-long observance of American Heart Month on the Talk Ten Tuesdays weekly Internet radio broadcast with an upcoming guest appearance of Cardiologist Harry B. Peled, MD with St. Jude Medical Center in Fullerton, Calif. Last Tuesday, Dr. Mahesh Amin reported on the use of new protocols centered on high-sensitivity troponins for the diagnosis of type 2 myocardial infarction (MI). The response to his appearance was overwhelming; hence the continuation of this timely and crit...
Feb 28, 2023•30 min•Season 13Ep. 543
Last year, the Food and Drug Administration (FDA) issued its approval of using new protocols centered on high-sensitivity troponins for the diagnosis of type 2 myocardial infarction (MI). Reporting our lead story during the next edition of Talk Ten Tuesdays will be Dr. Mahesh Amin, CV Service Line Medical Director for BayCare Health Systems in Clearwater, Fla., a board-certified cardiologist. This story, along with a Feb. 28 report by Henry Peled, MD at St. Jude Medical Center in Fullerton, Cali...
Feb 21, 2023•30 min•Season 13Ep. 542
In continuing our observance of American Heart Month, during the next live edition of the Talk Ten Tuesdays live Internet radio broadcast we will zero in on the topic of coding and clinical documentation integrity (CDI) issues related to cardiovascular procedures – and, specifically, the importance of obtaining pre-authorizations for cardiology procedures. Obtaining cardiology procedure pre-authorizations tends to be a time-consuming process, depending on the complexity of the patient’s insuranc...
Feb 14, 2023•30 min•Season 13Ep. 541
February is American Heart Month, a time to raise awareness of cardiovascular health and to shine the light on cardiac issues, especially myocardial infarction. Unfortunately, every year about 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds. And that is why we invited the Chief Executive Officer for the Innova Revenue Group, Lidiya Ter-Markorova, a clinical documentation integrity expert, to discuss documentation and coding pain poi...
Feb 07, 2023•29 min•Season 13Ep. 540
Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Respiratory Therapy All Access Pass , and why it is an important product for healthcare professionals.
Feb 01, 2023•3 min
As rural hospital closures continue to increase (136 have occurred between 2010 and 2021), health information management (HIM) and clinical documentation improvement (CDI) professionals have key roles in ensuring revenue integrity and optimization essential to sound operations and access. Even so, small facilities, especially those operating independently, simply do not have the resources that larger chains have to negotiate favorable payer contracts and to implement processes, technologies, and...
Jan 31, 2023•33 min•Season 13Ep. 539
Who knew that when the venerable American Medical Association’s (AMA’s) combining two hospital encounter service types into one code set of inpatient/observation services – initial and subsequent – consternation would be the outcome. The confusion: what entity can actually bill an inpatient initial code, 99221-99223, and who must default to subsequent codes or report office and other outpatient codes when seeing patients in the observation setting? The good news: during the next live edition of ...
Jan 24, 2023•30 min•Season 13Ep. 538
The term “DRG mismatches” is most often used to describe situations wherein the working diagnosis-related group (DRG) selected by the clinical documentation improvement specialist (CDIS) differs from the final coded DRG, signaling that the CDIS and the coder have arrived at different principal diagnoses. In other situations, a procedure may have been coded incorrectly by the CDI professional, causing the DRG mismatch. But here’s good news: there’s a new workflow for resolving inpatient DRG misma...
Jan 17, 2023•30 min•Season 13Ep. 537
Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Nuclear Medicine All Access Pass , and why it is an important product for healthcare professionals.
Jan 12, 2023•3 min
Within the hospital setting, the term “mismatch” is most often used to describe a situation wherein the final working diagnosis-related group (DRG) selected by the clinical documentation improvement (CDISs) specialists from the final coded DRG. This can be due to many reasons. One of the most frequent reasons is that the CDI professional and coder have arrived at a different principal diagnosis. In other situations, a CC (complication or comorbidity) or MCC (Major CC) may not have been coded by ...
Jan 10, 2023•29 min•Season 13Ep. 536
Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Infusion & Injection All Access Pass , and why it is an important product for healthcare professionals.
Dec 14, 2022•3 min
Telehealth is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state. When the public health emergency (PHE) was declared in March of 2020, most states, followed the federal exceptions under the 1135 CARES Act waivers, allowing, an out-of-state provider to render services via telemedicine in a state where they are not located, or allow a clinician to provide services via telehealth in a state if certain co...
Dec 13, 2022•32 min•Season 12Ep. 535
New codes. Old codes. Deleted codes. ICD-10 codes, evaluation and management (E&M) codes, and Z codes. It’s raining codes, and during the next live edition of Talk Ten Tuesdays, you’ll hear the very latest coding news – along with all you need to know to keep you performing at the top of your game. The live broadcast will also feature these other segments: CDI Report: Cheryl Ericson, a recognized clinical documentation integrity (CDI) subject matter expert, will report on the latest CDI news...
Dec 06, 2022•29 min•Season 12Ep. 534
