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How Risk Adjustment and HCCs Are Impacting Coding and CDI

Are you hearing more about risk adjustment methodologies and Hierarchical Condition Categories (HCCs)? No doubt you are. That's because they impact coding, clinical documentation integrity activities and reimbursement. So what impact can you have on any of these issues? During this episode Marie A. Morin, director at Alvarez and Marsal Healthcare Industry Group LLC, reports on her experiences in assisting clients with risk assessment, coding and documentation practices. Other segments...


Wage Disparity and the Gender Gap: Probable Causes for Burnout?

The recent Doximity research study that revealed an average national wage gap between male and female physicians of $105,000 was greeted by some healthcare professionals as "old news," while to others it seemed one more thread in the national fabric of the discussion on women's rights in the era of #metoo. Yet this income disparity could also contribute to physician burnout—a diagnosis that is higher among female physicians than their counterparts. In 2017, the national gender gap for...


MIPS: Maligned and Misunderstood

Maligned and misunderstood, the Merit-Based Incentive Payment System (MIPS) is under assault, as industry experts are urging officials at the U.S. Department of Health and Human Services (HHS) to consider repealing the program. Yet March 31 was when eligible clinicians were to submit their quality data by for the value-based reimbursement program. Delivering an update on MIPS during this episode is nationally recognized revenue cycle authority Lyman Sornberger, chief strategy officer for...


Medicare Beneficiaries to be Carded

Medicare beneficiaries will soon be receiving from the Centers for Medicare & Medicaid Services (CMS) new identification cards—cards that will use a unique and what CMS describes as a "randomly-assigned number" called a Medicare Beneficiary Identifier (MBI). The new number replaces the Social Security-based Health Insurance Claim Number (HICN). The new cards, scheduled to be mailed next month, are designed to help combat identity theft and fraud. Reporting our lead story is author,...


Myocardial Infarctions: The Impact on Mortality Rates

We will continue to focus on cardiology during this episode, as Jeffrey E. Epstein, MD, FACPA, appears as a special guest along with Glenn Krauss. Together the pair co-authored a paper titled "Physician Documentation Impacts Hospital Mortality Rates for Acute Myocardial Infarctions." Dr. Epstein reports on the need for better physician documentation to achieve better clinical outcomes – and why the challenge, of course, is physician education. Other segments featured in this episode...


The Continuous Challenge to Code and Document COPD Compliantly

Chronic obstructive pulmonary disease (COPD) continues to be a challenge to code and document – its coding in particular, and its sequencing, can be difficult. As a medical diagnosis, COPD is one of the most frequently searched terms on the Internet. Shedding light on this subject during this episode of Talk Ten Tuesdays is Nelly Leon-Chisen, the director of coding and classification for the American Hospital Association (AHA). Last Tuesday and Wednesday, the federal ICD-10 Coordination...


Live Reporting on the ICD-10 Coordination and Maintenance Committee

The federal ICD-10 Coordination and Maintenance Committee (C&M) is scheduled to meet Tuesday and Wednesday, March 6 and 7, to discuss proposals for diagnosis code topics, with the conversation to be led by the Centers for Disease Control and Prevention (CDC). Join Chuck Buck and Erica Remer, MD during this episode, as coding educator and consultant Laurie Johnson reports on the ongoing deliberations during the C&M meeting, which will take place at the headquarters of the Centers for...


Baltimore’s Best and Brightest Breaks Down Barriers in Health

February is Black History Month, and Talk Ten Tuesdays is recognizing it with an appearance by Dr. Crystal Watkins, who shares thoughts about her ascension from an African-American student in the Baltimore City Public Schools to becoming an MD, PhD, neuroscientist, and finally director of The Memory Clinic at Sheppard Pratt Health System. Dr. Watkins' appearance coincides with news that the American Hospital Association (AHA) this past week announced that it will allow notes from social...


How Cardiology Diagnosis Coding Will be Impacted in 2018

February is American Heart Month, and in recognition of this national focus, this episode of Talk Ten Tuesdays will center on how cardiology diagnosis coding for myocardial infarction (MI) is being impacted in 2018. There are now five types of MI code categories. Joining the podcast as our special guest is Terry Fletcher, who reports on these new options and how they will impact your reimbursement. Other segments featured in this episode include: News Desk: CDI Report: Tuesday...


Medical Necessity vs. Medical Decision-Making

Are medical decision-making and medical necessity one in the same? Often, bad advice tends to circulate regarding how to select the correct evaluation and management (E&M) codes. Healthcare attorney David Glaser was the first to break a news story involving Highmark’s recent policy – evidently recently rescinded – that required physicians to use medical decision-making as a key component of coding. Reporting our lead story during this edition of Talk Ten Tuesdays is David Glaser, who is...


Unraveling the Mystery of OB Coding

Renal disease has been complicating obstetrics coding. For the first time on Talk Ten Tuesdays, two subject matter experts delve into this subject, which is rife with confusion and contradiction. The key question is this: is renal disease a medical condition caused by the pregnancy, or a preexisting medical condition complicating the pregnancy? That is why we asked Linda Holtzman from Clarity Coding, Inc., to help explain when to use O26 and O99 codes. Podcast co-host Dr. Erica Remer and...


Coding and Documenting Chronic Conditions

Coding chronic conditions and co-morbidities is becoming increasingly critical as the healthcare landscape shifts toward value-based care, which attempts to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs. Reporting our lead story on this edition of Talk Ten Tuesdays is Machaelle Diaz, senior program manager for coding quality review and education at McKesson Specialty Health. Other segments...


Six New Perspectives for Coding and CDI Programs

Senior healthcare consultant Michelle Wieczorek returns to discuss six ideas she says will improve performance indicators for coding and clinical documentation integrity (CDI) departments. Wieczorek, who is a senior manager in the DHG Healthcare CFO advisory team, also discusses the ever-increasing importance of Hierarchical Condition Categories (HCCs) in the world of value-based care. Other segments to be featured this episode include: Tuesday Feature: DocTalk: RegWatch: CDI...


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