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A 7 percent payment update in your professional claims is at stake. That’s a nice bonus on top of the automatic 0.5 percent update to the Physician Fee Schedule (PFS). This is the last year for the automatic update, however. The only shot clinicians have at a PFS payment update in 2020 and beyond is […]
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Make sure your staff knows and implements your policy on continuous observation of suicidal patients, check and recheck that air pressures are appropriate to the room, update infection control procedures to the latest recommendations, and be prepared for surprise surveys.
Bec we are in a rural area and not a lot of specialists here, we see a lot of complex patients. We are getting swamped with request for records from insurances, like 120 from BCBS, 80 from Humana, 50 from Aetna, etc.
We are drowning and had to pull resources to be able to comply with this requests.
I understand that it is in the contract that we should pull the records as requested but i think it’s unfair that the insurances are getting money from the government, and we are doing all the work.
Any thoughts?
I am looking for feedback and ideas from both providers and health plans on year end pushes to get coding gaps closed.
We have been working hard all year both on the plan side as well as the provider side to see members/patients, assess their chronic conditions, and get them documented & coded but as we all know it seems we always have more gaps to close!
I am looking for any ideas to try over the next 30 days that may help us exceed our goals in risk adjustment. I would love to hear some provider thoughts on what works best for you at the end of the year and how the plan can maybe assist you in getting members in or different strategies you may be trying.
Wishing you all a happy and safe holiday season!
Nicole Martin
Coding:
E11.9, I12.9, N18.3
or we should code:
E11.22, I12.9, N18.3
Example #2
Provider’s documentation states:
DM
Hypertension with CKD III
Coding:
E11.22, I12.9, N18.3
Coded as guidelines stating.
Example #3
Provider’s documentation states:
DM without complications
Polyneuropathy
Coding:
E11.42
or we should code:
E11.9, G62.9
Example #4
Provider’s documentation states:
DM
Polyneuropathy
Coding:
E11.42
Coded as guideline stating.
Guidelines:
ICD10-CM presumes cause and effect linkage between DM and certain conditions unless the physician specifically indicates the conditions are not related. Conditions that appear in the index as indented subterms under the various types of "diabetes, with" are coded as diabetic complications, even in the absence of the physician documentation explicitly linking them, unless the documentation clearly indicates these conditions are not caused by diabetes for example, by stating:
Actual nondiabetes related cause
Cause is not diabetes
Diabetes is without complications
Cause is unknown.
Any help is much appreciated.
Thank you.
I work for a small independent family practice (three doctors and one nurse practitioner) and am the only coder/biller in the office. We are in risk agreements with a few of our payers. I’d like to know how other similar offices organize their coding/billing departments. Currently I scrub the charges passed from the providers via the EHR for E/M compliance and dx coding accuracy, send the claims, and work the denials. The providers here are not fabulous coders so scrubbing the claim for dx code accuracy takes a lot of time and querying.
I’ve worked through the CRC study guide but haven’t taken the exam. I understand how and why we’d code for risk. My question is how does everyone find the time to do all of the auditing? Are the providers you code for really good at selecting their E/M and dx codes including risk codes? Do you have more than one coder in the office? Any guidance is appreciated.
Thanks,
Stephanie Saylor CPC
I work for a small independent family practice (three doctors and one nurse practitioner) and am the only coder/biller in the office. We are in risk agreements with a few of our payers. I’d like to know how other similar offices organize their coding/billing departments. Currently I scrub the charges passed from the providers via the EHR for E/M compliance and dx coding accuracy, send the claims, and work the denials. The providers here are not fabulous coders so scrubbing the claim for dx code accuracy takes a lot of time and querying.
I’ve worked through the CRC study guide but haven’t taken the exam. I understand how and why we’d code for risk. My question is how does everyone find the time to do all of the auditing? Are the providers you code for really good at selecting their E/M and dx codes including risk codes? Do you have more than one coder in the office? Any guidance is appreciated.
Thanks,
Stephanie Saylor CPC
In a live question-and-answer session, Kathryn Petrovic, MSN, RN-BC, The Joint Commission’s (TJC) field director of surveyor management and development, and Emily Wells, CSW, MSW, TJC’s project director of surveyor management and development, offered answers to some of those questions.