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CPT Updates

CPT Changes for 2020 – Part Two

By Teri Jorwic / January 10, 2020 / 0 Comments

CPT 2020 changes took effect on January 1, 2020. In Part 2, we continue with a discussion of revisions in the Evaluation and Management, and Medicine sections, along with an overview of updates in the Radiology, Pathology and Laboratory, and the new Category III codes.

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ICD-11

ICD-11 Overview

By Karen Youmans / January 6, 2020 / 0 Comments

The World Health Organization (WHO) recently released the 11th edition of the International Classification of Diseases (ICD-11). This release was presented at the World Health Assembly on May 25, 2019 for adoption by member states, and will come into effect on January 1, 2022. However, note that it is still unknown when ICD-11 will be ready for implementation in the United States.

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2020 CPT Code Changes

New Year, New Codes: CPT Changes for 2020

By Teri Jorwic / December 30, 2019 / 0 Comments

As we turn the calendar to a new decade, the 2020 CPT code changes take effect. This year there are a total of 394 changes to CPT, bringing the total number of codes to 10,471. This includes 248 new codes, 71 deletions, and 75 code revisions, according to the American Medical Association (AMA). This is Part 1 of a 2-Part Series. In this article, we will discuss the changes in the Surgery Section.

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Medicare Advantage

Medicare Advantage Insurers Use Reviews to Get Higher Payments

By YES HIM Consulting / December 20, 2019 / 0 Comments

An investigation by the Office of Inspector General (OIG) revealed Medicare Advantage insurers might be overstating patients’ diagnoses without the proper documentation to receive larger payments. Based on the 2016 Medicare Advantage encounter data analyzed by the OIG, insurers were able to get an extra $6.7 billion in payments in 2017.

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strategic planning

Crafting Your Organization’s Strategic Plan For A Successful Year

By YES HIM Consulting / December 18, 2019 / 0 Comments

The healthcare and health information management industry is no stranger to constant changes and evolutions. To successfully navigate the future – and be prepared for anything – healthcare organizations need to craft a strategic plan. A strategic plan is beneficial for everyone: It allows the company owner to identify which goals will help grow the organization, and it helps the employees foster that growth by accomplishing the necessary objectives and increasing productivity.

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Optimal Quality Coding

Optimal Quality Coding Prevents Medical Claims Denials

By YES HIM Consulting / December 16, 2019 / 0 Comments

Medical billing denials generate significant cost for providers and hospitals that could be avoided by improving claims data management and optimizing medical coding processes. Optimal quality coding effectively prevents medical claims denials by reducing the potential for manual error and addressing concerns over fast approaching time limits.

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coding outsourcing myths

Top 5 Common Myths of Coding Outsourcing

By YES HIM Consulting / December 9, 2019 / 0 Comments

Assigning coding and auditing needs to outside companies allows providers to focus on the tasks that they enjoy doing, and leaves the other functions for experts who can get them done quickly and accurately, especially if the organization’s in-house staff is not trained in coding. These are 5 common myths of outsourcing, and how YES HIM Consulting debunks these concerns with a skilled team of consultants, coders, and auditors.

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Coding compliance

Should Secondary Medical Conditions Be Coded?

By YES HIM Consulting / November 18, 2019 / 0 Comments

Locating causes for denied claims can be a tricky process because staff is accustomed to assigning ICD-10-CM diagnosis codes based on the provider’s one major diagnosis documented in the medical record and assume the coding is correct if there isn’t a difference.  However, the lack of support for necessity of the bill might not be as obvious.

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Patient Safety Indicators PSI

How to Assess Quality of Care at Hospitals: Patient Safety Indicators

By John Franz / October 15, 2019 / 0 Comments

The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) to judge the quality of care at Hospitals.  The data can be used:

  • By patients to choose where they go for care
  • Third party payers to select facilities to contract for services
  • Assist QA departments identify potential problem areas
  • Help leadership assess. monitor, track, and improve patient safety
  • Determine financial gain or loss (CMS PSI 90, contract bonuses for quality)
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2020 ICD-10-PCS Guideline Changes: Make Room for Exceptions

By Teri Jorwic / October 15, 2019 / 0 Comments

Make Room for Exceptions: This years’ updates to the ICD-10-PCS Official Guidelines for Coding and Reporting include a new section, updates to an existing section, new guidance on a body part, some editorial changes and the introduction to the possibility of exceptions for special cases.

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