Talk Ten Tuesdays

Outsourcing versus offshoring – a debate long representing a tacit acknowledgment of how many U.S. facilities and physician practices approach coding and billing – has resurfaced as providers grapple with which to choose as the customary way to submit medical claims. Although once considered verboten, today this is more or less becoming mainstream, or the "new normal," with globalization...

The American Medical Association (AMA) CPT® Errata and Technical Corrections have clarified some grey areas found in the 2021 Evaluation and Management (E&M) Guidelines. But did the updates really help coders and physicians in better understanding how to apply the latest corrections? Apparently, there’s still confusion, according to Terry Fletcher, a nationally recognized physician auditor and...

Healthcare providers nationwide are scanning the horizon for the first signs of ICD-11, which is slowly making its presence seen and felt. However far in the future you might speculate the transition to ICD-11 to be, the reality is that preparation and planning will take time, and understanding the new concepts being introduced is a key starting point. And that will be where we start during the ne...

When the Centers for Medicare & Medicaid Services (CMS) began down the path of change that the American Medical Association (AMA) delivered in 2021 for the purpose of administrative burden relief, it was expected that there would be some initial investments of time necessary to create models of efficiency in a new era of documentation. But most providers have chosen to avoid it. The totality i...

It’s vitally important to remember that updates to the American Medical Association (AMA) CPT® code book might not be there when you need them. But since January of this year, the AMA has been receiving provider feedback: essential information that now been incorporated in the AMA 2021 CPT® Errata and Technical Corrections. Navigating these changes during the next edition of Talk Ten Tuesdays will...

There’s a new segment of the healthcare population that represents yet another opportunity for health information management (HIM) professionals to leverage existing staff and processes to improve their organization’s bottom line. That new segment: physicians employed by healthcare systems. During the next live edition of Talk-Ten-Tuesdays, nationally acclaimed HIM professional Rose T. Dunn, two-t...

A key (and occasionally overlooked) role of the physician advisor is advocacy: advocacy for physician partners, advocacy for quality patient outcomes, and advocacy for clinical medicine represented on committees, in board rooms, and to agencies defining national standards. During the next live edition of Talk Ten Tuesdays, Dr. Drew Updike, medical director of coding at UCHealth, and Dr. Debra Anof...

Every day, in facilities ranging from small rural hospitals to large academic teaching facilities and health systems, these dedicated professionals are working to keep patient health information data accurate, secure, and most importantly, personal. Because when it’s personal, it’s relevant. As part of our recognition of the importance of HIPs, please listen to HIP Voices, a podcast during which y...

ICD10monitor and Talk Ten Tuesdays will continue their reporting on the advent of ICD-11 – particularly during April, when attention turns to the World Health Organization (WHO). A key question that needs answering: where does the United States fall among the countries that are either preparing or even implementing the new update for the standard code set? For a global perspective on ICD-11 and th...

The World Health Organization (WHO) gave us the International Classification of Diseases (ICD), including several updates over the years, more recently versions 9 and 10. And now on the horizon is version 11. Thus, it is only fitting that Talk Ten Tuesdays would focus on the global accomplishments of the WHO this week, with the lead story for this upcoming edition focusing on the looming implement...

Implementation of the 21st Century Cures Act is set for Monday, April 5. In a nutshell, the legislation directs providers to cease all efforts of information blocking with respect to their electronic health records (EHRs), and to encourage and promote interoperability, allowing for communication and cooperation with third-party application program interfaces. With respect to portions of clinical n...

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) have announced a proposal for biannual ICD-10-CM and PCS updates. The impact on business processes would be far-reaching – much of it good, and some possibly not so good, according to Susan Gatehouse, who will report this development as the le...

To improve patient care and create transparency, Medicare mandated a pay-for-quality reporting program for hospital outpatient services in 2009. The related measures can impact hospital payment if not met, thus creating financial incentives for hospitals to report them. The measures are intended to evaluate the regularity of outpatient treatments known to provide the best results for most patients...

Whether you work for a full-scale enterprise or a smaller healthcare facility, the importance of revenue integrity programs is gaining increased importance, especially in the light of renewed auditing activities anticipated under the Biden Administration.   Beyond ensuring accurate billing and collection, revenue integrity should strengthen reimbursement performance and provide sound financial pra...

Will there be an ICD-10 code for post-traumatic visual disturbance? Or for an encounter for PPD test reading and medication review? Or prolonged grief disorder? In light of COVID-19, the ICD-10 Coordination and Maintenance Committee (C&M) meeting will be online-only, as was the case last spring, at the outset of the pandemic. This year, the two-day meeting begins next Tuesday, March 9, continu...

Infection rates from the coronavirus are declining. Vaccination rates are increasing. And while that’s good news, word on the ground is anything but good. Vaccination distribution in the U.S. has been, by most accounts, uneven, with reports of supplies not keeping up with demand in many states. And this week, a spate of bad weather, particularly in Texas and states across the Southeast, is hamperi...

They’re standing in long lines, often in the early morning darkness and in the cold, waiting for access to community vaccination centers all across the country. According to the Centers for Disease Control and Prevention (CDC), more than 1 million doses are being administered daily to grateful recipients. Yet there’s still the disturbing trend of vaccine hesitancy . Driven by misinformation, lack...

The Centers for Disease Control and Prevention (CDC) is forecasting that there will be more than 500,000 deaths from the coronavirus in the U.S. by the third week of February. In the meantime, the U.S. vaccine rollout fell short of federal projections, according to Bloomberg News, which noted that the initial round of shots, delivered through early January, was distributed through hospitals. Then...

The Centers for Disease Control and Prevention (CDC) is forecasting that there will be more than 500,000 deaths from the coronavirus in the U.S. by the third week of February. In the meantime, there has been a flurry of activity by major pharmaceutical companies to work together to help meet the huge demand for vaccines, all against the backdrop of an emerging trend: vaccine hesitancy . Driven by...

There has long been a focus on improving documentation for the purpose of maximizing the capture of complications and morbidities and major complications and morbidities (CCs and MCCs). As value-based purchasing is becoming more widely adopted, the importance of improving documentation is becoming more relevant. Case in point: the importance of coagulopathy documentation and its impact on perioper...

The U.S. death toll from the coronavirus is approaching the number of Americans killed in World War II, and as America is experiencing another surge of infections, the once-unthinkable subject of rationing care is now being debated. But how is care to be rationed? Is there a uniform guide for triaging care, as the availability of all beds, ICU beds, ventilators, and other hospital equipment is wei...

The Centers for Medicare & Medicaid Services (CMS) 2021 Final Rule and 2021 Medicare Physician Fee Schedule (MPFS) are effective Jan. 1, 2021, and both affect reimbursement. But in a rare move, CMS increased the conversion factor (CF) in the MPFS twice in one week as a result of the COVID-19 relief bill, which added a hike of 3.75 percent. For an update on the major CMS changes for 2021 that w...

Out in the West Texas “town” of El Paso, a number of COVID-19 patients are being treated with a new monoclonal antibody infusion called bamlanivimab. Now in the second week of the operation being conducted in the El Paso Convention Center’s makeshift hospital, Dr. Edward Michelson, Chair of the Department of Emergency Medicine at Texas Tech University Health Sciences Center, reports that while tre...

There’s a recently added CPT® code for personal protective equipment (PPE). But there’s a corresponding catch: who pays and who doesn’t, and what’s the best practice for handling the new normal in physician practices? Could the new code, 99072, although a payable service by Medicare, as well as commercial payers, wind up being a patient’s out-of-pocket expense? Reporting our lead story during the...

Thanksgiving, the flu season, and a dramatic surge of the COVID-19 pandemic are converging at a time when the nation’s coronavirus death toll has reportedly exceeded 250,000, with more than 11 million confirmed cases. With soaring infection rates come more testing, as well as more hospitalizations and deaths. A focus on COVID-19 testing will come into sharp relief as Talk Ten Tuesdays concludes it...