For years, providers have been plagued with defending claims for medically necessary services that have been denied due to insufficient documentation and technical reasons. This leads to the Medicare program and commercial...
Integrating COVID-19 into Coding and Clinical Documentation Integrity
Understanding how to clinically validate sepsis and differentiate between sepsis and septicemia is not easy, and requires a lot of time and effort. Sepsis is an overwhelming non-homeostatic response of the immune system to...
Skilled Nursing Facility Staffing Impacted by New Payment Rules
Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new Health Affairs study.
OIG: Hospitals are upcoding severity levels for Medicare patients
A new report from the Department of Health and Human Services' Office of the Inspector General uncovered a possible reason: Many hospitals are increasingly billing for inpatient stays at the highest severity level, which is...
Death of the Inpatient-Only List is NOT the Death of Medical Necessity
For readers of and listeners to RACmonitor and Monitor Mondays, overthinking things is what we do. It’s the only explanation for our hand-wringing over the death of the Medicare inpatient..
Payer Split-Bill Requirement: Separate Claims to Avoid Edit
In December 2020, the Centers for Disease Control and Prevention (CDC) announced six new International Classification of Diseases, Tenth Revision, Clinical Modification...
