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Healthcare Trends

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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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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How the Coronavirus Will Impact the Availability of Resources in Medical Facilities

By YES HIM Consulting / March 18, 2020 / 0 Comments

The recent global outbreak of the “zoonic” virus classified as SARS-CoV-2 and the disease that it causes (Coronavirus Disease 2019 or COVID-19) threaten to put a large-scale strain on the US health care system. This strain will be felt not least at the insular level in medical facilities where professionals seek to treat those suffering from respiratory distress brought on by COVID-19 – a scenario rife with potential difficulties for both patient and professional. The three main factors that distinguish COVID-19 from influenza are cause for concern and intensify the risk involved in both contraction and treatment. The problematic issue concerning the availability of material resources in medical facilities compounds this risk.

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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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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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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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New ICD-10-CM Code For Vaping-Related Disorders – Effective April 1

By Ann Zeisset / January 28, 2020 / 0 Comments

The WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) convened to establish a new emergency code to be used by WHO. This new emergency code, U07.0 – Vaping-related disorder, was implemented and valid for immediate use as of September 24, 2019, for ICD-10. In the United States, a Supplement to the ICD-10-CM Guidelines, entitled “Coding Encounters Related to E-cigarette, or Vaping, Product Use,” was posted on October 17, 2019. The guideline update provided valuable information on the proper assigning of codes, but did not provide a unique code for vaping in ICD-10-CM.

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ProFee Coding

Weighing the Differences and Similarities of ProFee and Facility Coding

By Vanessa Youmans / January 21, 2020 / 0 Comments

Physician group acquisition by major health systems remains a common trend in the industry. One survey of over 8,700 physicians indicates that only 31% of physicians surveyed identify as an independent practice owner or partner as of 2018. This is down from 48.5% in 2012, a whopping 35% decrease in independently owned practices in only 6 years (Merritt Hawkins, 2018). In these acquisitions, the question remains: Who will manage the physician group?

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