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Health Information Management

COVID-19 Code

Selecting the Right COVID-19 Code: Should You Use CPT or HCPCS?

By Teri Jorwic / April 1, 2020 / 0 Comments

On March 11, the World Health Organization (WHO) issued a declaration of the COVID-19 as a global pandemic. Two days later, the AMA announced the development of a specific code for laboratory testing for the coronavirus, code 87635 (AMA, 2020). The Centers for Medicare and Medicaid Services (CMS) released two new HCPCS codes for coronavirus testing for Medicare claims. The reporting for COVID-19 testing is dependent on the payer, either an HCPCS or CPT code should be used; there should not be more than one COVID-19 testing code on a given claim.

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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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COVID-19 MS-DRG Assignment

New COVID-19 MS-DRG Assignment, Effective April 1

By YES HIM Consulting / March 24, 2020 / 0 Comments

ICD-10-CM code U07.1 COVID-19 will be in effect as of April 1 in the US, which was pushed up from the normal effective date of October 1 for new codes. The reasoning for this unprecedented change is for the urgent need of immediate data collection. CMS has released a new update on 3/23/2020: “The ICD-10 MCE Version 37.1 R1 uses edits for the ICD-10 codes reported to validate correct coding on claims for discharges on or after April 1, 2020″ (2020). The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.

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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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Medical Trends

Emerging Medical Trends in Response to COVID-19

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

Preparations are underway for the incoming financial, organizational, and human burden that will be thrust upon hospitals and medical facilities across the nation due to the spread of the Novel Coronavirus and its corresponding disease (COVID-19). Health services worldwide are taking exceptional measures in order to better adapt to the pandemic. With certain problematic developments unfolding in foreign contexts determined to be ahead of the US in the timeline of coronavirus transmission, administrative officials in domestic medical facilities are undertaking efforts to shore up perceived shortcomings at local and regional levels. These are the emerging medical trends we will see in the coming weeks.

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COVID-19 code

Update: New ICD-10 Code For COVID-19 Effective April 1

By Teri Jorwic / March 18, 2020 / 0 Comments

The United States will begin using code U07.1 COVID-19 as of April 1 – rather than the usual effective date for new codes of October 1. This new code is being fast-tracked to allow for the urgent need of immediate data collection. Interim coding guidelines from the CDC are still to be used between now and the effective date (CDC, 2020). Review our previous article, “Coding for Coronavirus Outbreak: Interim Guidance from the CDC,” for additional information about code U07.1.

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Medical Coding & Billing Tips for COVID-19

By YES HIM Consulting / March 16, 2020 / 0 Comments

With the number of COVID-19 (2019-Novel Coronavirus) cases expected to rise in North America, the Centers for Medicare & Medicaid Services (CMS) has provided information on how to medically code and bill all encounters related to COVID-19 for Medicare beneficiaries (CMS, 2020).

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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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Medicare Payment Systems

Top 8 Changes Medicare Payment Systems Will See In 2020

By YES HIM Consulting / February 13, 2020 / 0 Comments

The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).

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Revenue Cycle

Strategies To Proactively Drive Revenue Cycle Efficiency And Reduce Cost

By YES HIM Consulting / February 3, 2020 / 0 Comments

Managing revenue cycles in healthcare businesses can be costly. However, if insufficient measures are taken to oversee good billing processes, collectible revenue is often left on the table. Constant annual changes in billing and coding rules make the processes especially frustrating, but smart strategic planning using relevant internal and external resources can help…

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