Talk Ten Tuesdays

The global coronavirus pandemic is worsening quickly, and at a time when winter is bearing down, forcing more of us to remain inside. In fact, health experts are predicting that confirmed daily cases of COVID-19 will climb above 200,000 nationally. 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...

As the nation is experiencing a dramatic surge in confirmed cases of COVID-19, the terms “false negative” and “false positive” accompany not only medical records, but also news media dispatches. The public health establishment and the medical world have generally treated positive results of PCR-based tests for the virus that causes COVID-19 as if they are infallible. The evidence shows that this m...

We are all participants in one of the most tumultuous times in the 21st century. A global pandemic rages throughout the United States and Europe, the consequences of which are tangible, but not yet fully quantified. A divisive political environment, exacerbated by 24/7 news and social media, has intensified our feelings about ourselves, our colleagues, neighbors, and family members. Stress and ten...

Amid the global COVID-19 pandemic, the 2020 presidential campaign, coding updates, and a tangle of regulatory waivers, it’s important to not to lose sight of the fact that ICD-11 for the United States is on the horizon. That’s why we asked Margaret Skurka, a voting member of the National Committee on Vital and Health Statistics (NCVHS) in Washington, D.C., who also sits at the table of the World H...

In the deadly throes of a global pandemic, Americans are struggling as they adjust to a confusing new normal. Halloween this year will portend an actual frightening threat. And America’s traditional Thanksgiving dinner will have an unwanted guest: COVID-19, the elephant in the room. The coronavirus continues to dominate headlines, family dinner conversations, political debates, congressional heari...

Once a frequent flyer with all the attendant privileges, senior healthcare consultant Deborah Grider was abruptly grounded when COVID-19 curtailed her coast-to-coast consulting. She first reported on her sequela from the coronavirus infection, the disease that causes COVID-19, for Talk Ten Tuesdays listeners in July. Now, she will return to the long-running broadcast to report on several other con...

Given the importance of medical review activities relative to the program integrity efforts of the Centers for Medicare & Medicaid Services (CMS), and regardless of the status of the current federal public health emergency (PHE), providers can expect imminent pre- and post-payment reviews, plus audits by Supplemental Medical Review Contractors (SMRCs) and the Recovery Audit Contractors (RACs)....

The Centers for Medicare & Medicaid Services (CMS) has ordered Medicare Advantage Organization (MAO), -hired subcontractors, to stop issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized.   Reporting our lead story during this edition of Talk Ten Tuesdays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health...

Battle lines in a budding court battle could be drawn soon. A federal appeals court has reversed the decision of a lower court and upheld the action by the U.S. Department of Health and Human Services (HHS) to pay formerly grandfathered off-campus outpatient departments run by hospitals at the same, lower rate of physician clinics. Experts believe that could mean a potential loss of $800 million t...

COVID-19 is disrupting the stability of food, shelter, and sleep. Stress levels are unthinkable.  The continuing pandemic, along with unemployment, racial injustice, and social isolation, is raising anxiety and depression to high levels as well. Moreover, it’s been reported that ongoing stress can decrease the body’s lymphocyte levels, making infection more likely. This cycle is evident among COVI...

The long-awaited and highly anticipated Inpatient Prospective Payment System Final rule was released late Tuesday afternoon, September 2nd.  Due to the rule being published Tuesday, Sept. 2, you and your team have precious little time to prepare for these changes since the IPPS becomes effective Oct. 1, 2020.  Joining us today for this special Talk Ten Tuesdays is Stanley Nachimson is a former CMS...

The Centers for Medicare & Medicaid Services (CMS) started rolling out post-payment audits again, as of Aug. 3, but now – after finding inconsistencies in the accuracy of some COVID-19 tests, and considering the fact that CMS has been paying an additional 20 percent to providers and facilities “treating patients with COVID or testing for COVID” – the agency has enacted a new mandate to qualify...

Plenty of time at home. Self-isolation. Binge-watching television shows. No commuting. Working remotely. You would think that with all the time spent at home these days, folks would be getting more and better sleep, right? Wrong! The truth is, according to Dr. Nick van Terheyden, that there are daunting obstacles to getting a good night’s sleep, with all the additional worries and fear induced by...

It’s out and it’s already creating controversy: the Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) proposed rule, which becomes effective January 2021. The rule, issued Aug. 4, would eliminate the Medicare inpatient-only list of services while increasing the number of Ambulatory Surgical Center (ASC)-eligible procedures. The rule would also increase...

The Centers for Medicare & Medicaid Services (CMS) has announced two new payment initiatives, with one being the use of "counseling" to help stop the spread of COVID-19.  CMS will make payment available to physicians and providers to counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested, and prior to the onset of symptoms. Howev...

COVID-19 is a disruptor of giant proportions. Case in point: The lead story for tomorrow’s Talk-Ten-Tuesdays was the ongoing COVID-19 pandemic, featuring Dr. John Foggle, who has spent the last three months working on the front lines in an urban, academic medical emergency department, treating COVID patients. Dr. Foggle had to cancel because he was asked to lecture on the deadly virus at Walter Re...

One day she’s consulting in Los Angeles. The next day she’s back in Indiana, with upcoming client calls scheduled at hospitals and physician practices in nearly every U.S. city and small town. Her frequent flyer miles would qualify for a round-trip to Mars. High-flying and always in demand as a speaker, Deborah Grider came crashing down, diagnosed with COVID-19 earlier this year. She’s recovering...

Choosing the proper office visit code can be confusing unless you fully understand rules between preventative medicine and evaluation and management (E&M) coding. Knowing the difference between preventive visits, with its many procedural services and bundled service codes, and E&M visits with its complicated coding and documentation guidelines, is imperative to correct office visit coding....

The use of telehealth has surged during the coronavirus pandemic, with the technology spreading far and fast. Doctors and patients alike must be wondering, 'is the beginning of a whole new kind of doctor–patient relationship'? One that will transform health care systems? With the uptick in the use of telehealth the Office of Inspector General (OIG) and Center of Medicare and Medicaid Ser...

Outpatient clinical documentation improvement (CDI) programs have moved into the mainstream, as hospitals and healthcare systems continue to embrace consulting companies’ push into the outpatient arena. As the CDI profession matures and the market for CDI consulting becomes more competitive and less lucrative, these companies have identified a new long-term revenue stream associated with consultin...

As the country begins to reopen, it is essential to have clear and accurate data for leadership to make informed decisions during the phased reopening. The U.S. Department of Health and Human Services (HHS) has recently announced guidelines for additional data to be reported to HHS by laboratories along with COVID-19 test results. These guidelines allow for standardization of reporting and ensure...

umbersome yet secure, your PPE is firmly in place as you shadow Dr. David Jury, similarly attired, as he makes his rounds in the ICU, explaining to you the handoff from his overnight telemedicine colleague…  Join for a remarkable, albeit virtual, journey into an ICU unit at the famed Cleveland Clinic, as our Talk Ten Tuesdays special guest Dr. David Jury describes his role as an anesthesiologist a...

When your team comes to the negotiating table with commercial payers this year, they’ll be doing so in the new normal: the coronavirus pandemic. Whether contract negotiations come during or toward the end of this country’s most devasting healthcare crisis in a century, this will be a whole new ballgame. Having wreaked havoc on institutions, policies, and procedures, the lingering effect of the pan...

“In my opinion, as a physician and an ex-physician advisor, I can categorically assure you that it would irritate a provider to get queried to confirm a diagnosis they had already made clinically and documented in a codable format,” writes Erica Remer, MD, Talk Ten Tuesdays program host-turned-correspondent, who will be reporting our lead story during this edition of Talk Ten Tuesdays. “I agree wi...

If physician documentation is missing or does not support the level or evaluation and management (E&M) service billed, surgery performed, or durable medical equipment (DME) issued, an addendum should be requested from the physician. A valid addendum must be received before the claim is submitted. Reporting our lead story during this of Talk Ten Tuesdays will be Terry Fletcher, nationally recog...