Coding Compliance

learning styles

Personalized Medical Coding Education Tailored to Coders’ Learning Styles

By YES HIM Consulting / July 7, 2020 /

YES HIM Consulting designs learning paths and coding tracks for busy professionals who need to take courses on their own time. Our catalog offers customizable formats to fit physicians’, coders’, and auditors’ schedules and learning styles – including on-site, online, and hybrid or blended models. Ongoing coding education is one of the ways to keep your team and organization compliant. Click here to review the other benefits of keeping your team up-to-date with coding and guideline changes with customizable coding education formats.

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hcc education

Webinar Recap for HCCs background and a deeper dive into M.E.A.T. Criteria

By YES HIM Consulting / June 30, 2020 /

In conjunction with TruCode’s Educational Series of free webinars, YES President and CEO, Karen Youmans hosted a webinar focused on HCC education and coding, and the application of the M.E.A.T. Criteria. The webinar, which was held twice due to popular demand, was attended by over 3,000 HIM professionals. If you missed the opportunity to attend either session, you can download the presentation slides here. We will recap the main points made during the webinar, and provide additional resources to help you and your organization become HCC experts.

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professional fee coding

Eliminate These Professional Fee Coding Risks to Save Your Bottom Line

By Vanessa Youmans / June 16, 2020 /

Many facilities, when completing a merger or acquisition, bring together professional fee coding and facility coding departments in order to increase productivity and claims reimbursement, but that’s easier said than done. These healthcare facilities must first consider if they have the knowledge base to accurately document and code professional fee services. The risks of inaccurate professional fee coding could be detrimental to your organization’s revenue and overall success.

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telehealth policies

Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19

By YES HIM Consulting / June 10, 2020 /

Due to the ongoing PHE regarding the 2019 Novel Coronavirus (COVID-19) outbreak, CMS has issued an interim final rule (IFC) to provide guidance on the updated telehealth policies and other services (CMS, 2020). The current PHE has relaxed many supervision requirements, allowing for supervision to be provided through audio/video telecommunications. Telehealth policies and procedures have been expanded further, and now include E/M services for emergency department visits, critical care services, nursing facilities, End State Renal Disease (ESRD) services, psychological/neuropsychological testing, and radiation treatment management (CMS, 2020).

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medical coding training

Medical Coding Training on Updates Ensures Accuracy & Compliance Standards

By YES HIM Consulting / June 3, 2020 /

Every year, the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA) release updated coding and reporting guidelines that make additions, deletions, and revisions to the ICD-10 and HCPCS code sets, and CPT codes, respectively. During Public Health Emergencies (PHE), such as the COVID-19 pandemic, CMS and AMA will release updates more frequently. By offering ongoing medical coding training to cover these quarterly and annual updates, your coding team upholds an accuracy standard and stays compliant with these revised guidelines. YES Education offers a robust catalog of medical coding updates that refreshes as the code set revisions are released, including quarterly and annual updates for ICD-10-CM/PCS and CPT.

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screening for COVID-19

COVID-19 Explained: Screening for Suspected COVID-19 Infection

By YES HIM Consulting / May 26, 2020 /

This article offers guidelines on how to code screening tests for suspected COVID-19 infection. There are two different kinds of tests for COVID-19: a viral test to detect a current Coronavirus infection, and an antibody test to confirm is the patient previously had COVID-19 (CDC, 2020). The CDC has issued guidance on conducting screening tests for COVID-19 and other recommendations for viral testing (2020).

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CMS guidelines for telehealth

CMS Guidelines for Telehealth Coding & Billing During PHE

By YES HIM Consulting / May 21, 2020 /

The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).

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How to Improve the DNFB Benchmark for a Positive Impact on Revenue Cycle

By YES HIM Consulting / May 21, 2020 /

One of the biggest revenue-killers for healthcare providers is DNFB accounts. DNFB (DNFB meaning “discharged, not final billed”) – defines unbilled accounts where the patient has been discharged from the healthcare facility, but the final bill from the encounter has not been submitted. The cost effects of outstanding DNFB accounts and claims denials are staggering, and can negatively impact the providers’ cash flow and potential net revenue. So, what are the best practices to reduce DNFB days and claims denials?

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Review the 2021 IPPS Proposed Rule’s MS-DRG & Other ICD-10 Coding Updates

By Teri Jorwic / May 18, 2020 /

The 2021 Proposed Rule for Inpatient Prospective Payment System (IPPS) was released on May 11, and will be published in the May 29, 2020, Federal Register (2020). Provisions in the rule increase the Medicare IPPS rate for hospitals that report quality data and are meaningful users of EHRs by approximately 3.1%, resulting in an increase of $2.07 billion in spending. With other adjustments, the overall payment increase for inpatient hospitals will be around 1.6%. The Proposed Rule adjusts the payment rates, MS-DRG codes, and other provisions, including new ICD-10-CM and ICD-10-PCS codes.

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HCC specificity

The Importance of Specificity in Documentation and Coding HCCs

By Karen Youmans / April 14, 2020 /

As a follow-up to our previous articles on the subject of Risk Adjustment and HCCs, we now review some scenarios of HCC chronic conditions and the importance of specificity in documentation and coding. Accurate and complete documentation of chronic condition diagnoses by clinicians is an essential component of the risk adjustment and the HCC process. It is also imperative that the documentation of a disease/condition be as specific as possible. Specificity can make a difference in the patient’s treatment plans, as well as accurate code assignments, which then leads to appropriate HCC assignment and payment.

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