Downgrading DRGs: A New York Epidemic Out of Control

Published: Mon, 09/19/16

Downgrading DRGs: A New York Epidemic Out of Control

Do you find that your facility’s DRGs are being downgraded by third-party payers that are re-diagnosing patients? Are they also discounting the coding of suspected and possible diagnoses? You’re probably not alone. Sonya Manuel, a senior health information management (HIM) consultant and DRG coordinator for Jzanus Consulting in New York, tells RACmonitor that the battle with third-party auditors has been going on for years.

 
Guideline Changes: Taking a Step Backward?

The recent buzz surrounding changes to the ICD-10-CM guidelines have many wondering why we appear to be taking a step backward from quality instead of elevating standards with language indicating that physicians don’t need to document to meet clinical indicators or support conditions with their documentation.

 
The End of Relaxed ICD-10 Rules: What it Means for Private Practices

Physician practices have had nearly a year to acclimate themselves to the ICD-10 coding that took effect in October 2015. Thanks to a grace period known as ICD-10 “relaxed rules,” which were established jointly by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA), the use of ICD-10 codes that did not meet the highest level of specificity requirements was allowed to continue without the risk of punitive action.

 
CMS ICD-10 Coding Grace Period Comes to a Halt October 1, 2016

Since the update from ICD-9 to ICD-10, has your business successfully made the transition to the new coding system, or are you still struggling to keep up? If it’s the latter, very little time remains! According to CMS, October 1, 2016, will be the cutoff date for the use of...

 
Ten Things About Oct. 1 That You Need To Know Now!

The 2017 Inpatient Prospective Payment System (IPPS) final rule brings with it a number of changes that are likely to have an even bigger impact on documentation, coding, and revenue than ICD-10 itself. An unprecedented number of dramatic changes will...