What’s New!

Payer Intelligence, Part 3: Understanding Commercial Medical Policy By Rayellen Kishbach, Director of Business Development for Policy Reporter In Parts 1 & 2 of the Payer Intelligence series, we looked at Medicare National guidance by the Center for Medicare & Medicaid Services (CMS) and State-specific Medicare Local Coverage Determinations & Coding Articles published by the Medicare Administrative Contractors (MACs). This article shifts attention to commercial payers and the medical policy and related documents they publish. While over 64 million people are Medicare beneficiaries, a much larger number of people in the US have commercial medical insurance, served by hundreds

 By Cynthia Tang, RHIA, CCS I have noticed that individuals with the greatest level of understanding are the ones most able to communicate what is essential in the fewest possible words. They don’t need to deliver a 'word salad' within which an answer may be hiding. Because they understand the topic so well, they express their thoughts simply and directly. This is relevant to those of us who work closely with medical documentation. The ‘cut and paste’ capability of electronic medical records (which seemed like such a timesaver!) actually obscures what is really important rather than focusing attention on what

By Lisa A. Eramo, MA People leave managers, not companies. In fact, 53% of working Americans who left a job due to workplace culture say they left specifically because of their relationship with the manager, according to a new report titled, The Culture Effect: Why a Positive Workplace Culture is the New Currency published by the Society for Human Resource Management. In addition, managers account for at least 70% of variance in employee engagement scores, according to a recent Gallup report. It's not surprising why managers can make or break an employee’s experience. Just like people, there are many types

By Susan H. Fenton, PhD, RHIA, FAHIMA; The University of Texas Health Science Center at Houston, School of Biomedical Informatics One of the hottest topics in health care right now is the adoption of machine learning (ML) and artificial intelligence (AI). This article will provide some basic definitions, as well as some tips for dealing with ML and AI in practice. Let’s start with definitions. Machine Learning: According to IBM, “Machine learning is a branch of artificial intelligence (AI) and computer science which focuses on the use of data and algorithms to imitate the way that humans learn, gradually improving

By Joseph Rivet, Esq., Founder, Rivet Health Law, PLC Your organization receives an overpayment letter; in bold letters, you see a huge number and likely a brief mention of extrapolation. Stop! It is critical to fully understand the overpayment or demand letter and all authorities the payer relied on to determine the alleged errors and application of extrapolation. What is extrapolation? Extrapolation is a statistical sampling methodology used by the Centers for Medicare and Medicaid Services (“CMS”), the Department of Justice, and government contractors. The extrapolation method takes a sample of claims to estimate an overpayment across a large universe

By Ann Barnaby, CPC, CRC, CASCC Preparing for an interview is almost as important as the interview itself. When a call comes in to schedule an interview with a company, the first step is, of course, celebration! The second step is preparation. Confidence during an interview is key to presenting your best self, and preparation encourages your confidence. Arriving at an interview with information on the company, your interviewer, and the position at hand will ensure confidence, and ensure a successful meeting. If you’ve applied to a job at a company or organization, you’ve probably already completed research before submitting

by Cari A. Greenwood, RHIA, CCS, CPC, CICA Education Specialist, Libman Education In the coding profession, credentials matter. They signify to employers and peers that you have mastery level coding skills, and that you will adhere to the rigorous ethical standards of our profession. Getting a credential is a significant step on the career path of most coders. The question for a coder becomes: Is earning a credential the right thing to do at this time and which credential is right for me? If you are experienced in coding health services provided in physician offices, group practices, multi-specialty clinics, or

Payer Intelligence, Part 2: NCD vs. LCD, Understanding Local Policy for Medicare Beneficiaries By Rayellen Kishbach, Director of Business Development for Policy Reporter In Part 1 of the Payer Intelligence series, we learned that the Center for Medicare & Medicaid Services (CMS) publishes National Coverage Determinations (NCDs) to establish medical policy at the national level. This article provides an overview of medical policy published by the Medicare Administrative Contractors (MACs) who manage the Medicare programs at the state level. Local Medicare Policy is published as Local Coverage Determinations and Articles CMS coverage policy is communicated in “National Coverage Determinations” (NCDs) that

By Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA I think the most powerful guideline is A11. While it uses the example of distinguishing between ICD-10-PCS root operations Excision and Resection, it is far more than that. This is the guideline that gives us coders the power to think for ourselves as we read and interpret clinical documentation and translate it into codes. With this great power comes great responsibility. Never is our coding responsibility greater than when we prepare for the code set updates each year, when there are all kinds of things to learn. - Coders have a responsibility to

  By Melanie Kiss-Endicott, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CCS-P, FAHIMA The demand for experienced, certified medical coders is a constant challenge for healthcare organizations. One solution for this demand is outsourcing medical coding to companies with offshore coders to supplement your current team. There are several benefits to offshoring, including cost savings, a highly qualified labor pool, and turnaround time. Let’s answer some of the commonly asked questions about offshore coding. How does the time difference of offshore coders affect business? It enhances business! When the U.S. coding workforce is finished with their day and relaxing at home

By Rose T. Dunn, MBA, RHIA, CPA, FACHE As health information professionals, we have an obligation to promote the integrity of our organization’s health information. Health information integrity means our clinical staff creates documentation that accurately and completely reflects the conditions addressed at the time of encounter and coding professionals strictly apply the CMS Guidelines and RADV rules when assigning the codes to conditions reported. So how does one know if their manner of coding is going to be acceptable? While there are a number of items to keep in mind when assigning codes, the most beneficial in my opinion

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Radiofrequency ablation for atrial fibrillation (pulmonary vein isolation), additional radiofrequency ablation for atrial fibrillation (roof line), additional radiofrequency ablation for atrial fibrillation (posterior line with isolation of posterior wall), additional radiofrequency ablation for supraventricular tachycardia (mitral annular line), additional radiofrequency ablation for supraventricular tachycardia (cavotricuspid isthmus line), additional radiofrequency ablation for atrial fibrillation (CFAE lesions along coronary sinus). Would the correct coding of this procedure be 93656, 93657 x 2 (box-roof line and posterior wall then CAFE lesion) and 93655 x 2 (mitral annular line and cavotricuspid)? Does it

By Lisa A. Eramo, MA Sarah B. Stone worked in medical transcription for 15 years before she decided to pursue a career in outpatient medical coding. “I was looking for a change,” she says. “I was doing a lot of contract transcription, and I didn’t want to edit. I’m happy I made the change to coding and wish I’d made it sooner.” To become an outpatient medical coder, she took an online medical coding course, obtained her CPC credential, and started working as an emergency department (ED) coder. Two years later, she decided to pivot once again, this time into

by Ann Barnaby, CPC, CRC, CASCC I don’t know about you, but sometimes it can feel like I can’t even remember what I did this morning, let alone the work I completed over an entire year! A work journal is a quick, effective way to jot down accomplishments you’ve met, projects that you’ve worked on, and milestones you’ve achieved. A work journal is different from the detail of tracking your daily productivity to record of your daily work and quality. A work journal will have periodic entries, and acts as your own personal HR record for your personal performance. Your