Being nice can get you in trouble. But as David Glaser, Dr. Ronald Hirsch, and I have said over and over, being nice and putting patient care first should be the excuse during this COVID pandemic for future Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits. We believe that when you err or if you err, err on the side of the patient.

CMS recently released the fiscal year (FY) 2021 ICD-10-PCS code set, which includes 544 new codes for Fragmentations of the veins and arteries, Drainages of the pelvic cavity, and Imaging of various organs. It also released the FY 2021 ICD-10-PCS Official Guidelines for Coding and Reporting.

From a compliance exposure perspective, we believe that the HIPAA risk associated with sending PHI abroad is simply untenable. HIPAA is an American law that does not extend beyond our borders. The only way to ensure HIPAA protection abroad is to do so contractually via a BAA.  There is no regulatory authority abroad for the...

A lot of information is appearing very fast about COVID-19 (coronavirus disease 2019), and medical coders have the extra challenge of sorting through the onslaught to find the bits relevant to coding claims related to testing and treatment. This Q&A brings together the latest authoritative news about coding for COVID-19.

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to amend the methodology and other requirements for the U.S. Department of Health and Human Services’ risk adjustment data validation (HHS-RADV) program. HHS-RADV was created to strengthen the...

Some doctors don’t understand how coders compliantly select codes. This can set up coding-clinical disconnects. Frankly, I don’t always get it myself, and I’m pretty good at this coding thing.

While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank on: oversight of incentive dollars will be a regulatory priority. In fact, federal watchdogs are not wasting any time, as reports...

Faced with the unique circumstances under COVID-19, many skilled facilities are wondering how to make ends meet.  First things first: proper infection control procedures, getting proper personal protective equipment (PPE), and limiting the infiltration of COVID-19 into your...

The Centers for Medicare and Medicaid Services (CMS) released the final FY21 ICD-10-PCS codes on May 28, 2020 which was earlier than expected.  The table below will show the changes between Final FY20, Proposed FY21, and Final FY21: