YES HIM Consulting, Inc. Your Consulting Firm for Auditing, Coding and Education

Electronic Health Records

Artificial Intelligence

Artificial Intelligence in Healthcare: How Natural Language Processing Can Benefit the Medical Field

By YES HIM Consulting / March 31, 2020 / 0 Comments

Artificial intelligence (AI) can help transform patient data into value at an accelerated pace without incurring high costs or eating up limited time and resources (Wolters Kluwer, 2020). The AI algorithms produce insights into treatments, care processes, diagnostics, and patient outcomes (Health IT Analytics, 2018). Natural Language Processing (NLP) tools, one branch of AI, “include applications such as speech recognition, text analysis, translation, and other goals related to language,” according to Future Healthcare Journal (2019).

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Coding

An Introduction To Medical Coding & Basic Terminology

By YES HIM Consulting / March 23, 2020 / 0 Comments

Medical coding is the process of assigning numeric or alphanumeric codes to the diseases, injuries, treatments, and procedures that healthcare providers perform to record each encounter accurately and correctly bill the patient (Healthcare Business & Technology, 2019). Medical coding directly ties into medical billing, which includes “preparing billing claims and submitting them to insurance providers,” as noted in our previous article, “What Is Medical Coding and Billing? How Does It Streamline a Hospital’s Financial Performance?” Ensuring the encounter was coded correctly with the right terminology is essential for correct payment and an accurate patient medical history.

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E/M

Increase Revenue & Lower Compliance Risk With These 6 E/M Tips

By YES HIM Consulting / February 20, 2020 / 0 Comments

Selecting the right E/M code can be tricky – and sometimes, costly – business. On the one hand, the coder does not want to choose a diagnosis that’s too high, which could potentially incur audits or claims denials. But, if the coder selects a code that’s too low, there’s a chance of losing revenue for his or her organization. According to Medical Economics, “payers and auditors use a quantitative scoring process that requires specific elements (i.e., history, exam, and medical decision-making [MDM] – or time spent counseling and coordinating care) for each E/M level” (2020).

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Appropriate Use Criteria

Changes to Appropriate Use Criteria for Advanced Diagnostic Imaging

By Vanessa Youmans / February 5, 2020 / 0 Comments

Starting January 1, CMS began testing the condition for Appropriate Use Criteria (AUC) requiring a qualified Clinical Decision Support Mechanism (CDSM) consultation by a qualified provider for payment on Advanced Diagnostic Imaging for Medicare beneficiaries. Claims must include the ordering professional’s NPI, which CDSM tool was utilized for the consultation, and “whether the service ordered would or would not adhere to consulted AUC or whether consulted AUC was not applicable to the service ordered” (Medicine Learning Network, 2018). The program will be fully implemented by January 1, 2021.

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M.E.A.T. Criteria

HCC Chronic Conditions and M.E.A.T. Criteria

By Karen Youmans / January 13, 2020 / 0 Comments

As a follow-up to our previous articles “The HCC Coding Specialist: Benefiting payers, providers, and patients” and “HCC Medicare Advantage background and overview,” we now review HCC chronic conditions and the M.E.A.T. documentation criteria.

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Medical Data

Is Your Medical Data At Risk? – Part Two

By YES HIM Consulting / January 8, 2020 / 0 Comments

As a follow-up to our previous article, “Is Your Medical Data At Risk? – Part One,” we now examine how personal health information could be used in the hands of technology companies outside of the medical industry. Representatives from Google and Ascension have said the medical data will be used solely to develop software that will make suggestions for patient care.

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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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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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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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Understanding ICD-10 Codes and Why They’re Important

By YES HIM Consulting / September 10, 2019 / 0 Comments

Every disease, injury, and symptom has its own ICD-10 code. But what exactly is their purpose and what makes them so important?

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YES HIM Consulting, Inc. Largo, Fl.
Office: (727) 531-3839       Fax: (727) 240-4592