Talk Ten Tuesdays

Waivers, modifiers, lab tests, multiple diagnosis codes: they constitute layer upon layer of intricacies that could get in way of your reimbursement. That is why accurate COVID-19 coding cannot be overlooked when ensuring appropriate compensation and safeguarding claims against third-party payer audits. Reporting our lead story during this edition of Talk Ten Tuesdays is Susan Gatehouse, founder a...

It’s coming. And it could soon be spreading, as is the coronavirus: healthcare fraud and abuse. After all, there’s lots of money involved, at a time when waivers have been issued and rules relaxed, as the nation’s healthcare system focuses on fending off COVID-19. These changes include FaceTime, Skype, and telephone calls being reimbursed as telehealth and telemedicine services: a factor that can...

Most of us are working from home now. That’s quite amazing. During the month of July 2019, an estimated total of 4.7 million folks telecommuted, either full or part-time. Fast forward to the national stay-at-home edict, and now, according to Global Workplace Analytics, those working at home could possibly number 75 million. So, what new privacy concerns are emerging, with healthcare professionals...

The costs of managing prolonged ICU stays for COVID-19  patients, combined with lost revenue from decreased ambulatory visits and the cancellation of elective procedures, will have health systems and provider groups emerging from the ongoing pandemic with significant financial challenges.   It will be more important than ever to ensure that clinical documentation reflects the true complexity of ca...

Medical decision-making (MDM) and medical necessity are not the same thing. MDM specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. But which determines how you get reimbursed, when many healthcare professionals use these terms interchangeably?  The l...

The confluence of the global COVID-19 pandemic and the World Health Organization (WHO) designation of April 7 as World Health Day is fast approaching. Nonetheless, the organization is asking its global partners to take the time to recognize the work of nurses and midwives, acknowledging the “critical role they play in keeping the world healthy,” marking the raison d'être for the International...

Eighty percent of what influences a person’s health is related to non-medical issues such as food, housing, upbringing, social support, and income. These socioeconomic and psychosocial circumstances are known as the social determinants of health (SdoH). With the goal of allowing physicians more time with their patients, the American Medical Association (AMA) has made significant revisions to the O...

What are care management services, and are you capturing revenue associated with them?   Transitional care management (TCM), chronic care management (CCM), advance care planning (ACP), and behavioral health integration are among services you may already be providing for your patients. Good news: you can be paid for those services, as you’ll discover during the next live edition of Talk Ten Tuesday...

Will there be a code for EVALI? Or the use of e-cigarettes? Or one for the deadly coronavirus that the World Health Organization has now declared as a pandemic?  In light of the coronavirus outbreak, the ICD-10 Coordination and Maintenance Committee (C&M) meeting will be online only and convene Tuesday, March 17. The virtual meeting brings together representatives from the Centers for Medicare...

There are HIPAA privacy rights that reach farther than those of the average patient. And there are privacy provisions in the Patient Protection and Affordable Care Act (PPACA) that prohibit discrimination against this population of patients. But do these prevent discrimination against transgender patients? During this edition of Talk Ten Tuesdays, we asked nationally-recognized professional physic...

With more cases of the novel coronavirus (COVID-19) being reported in countries outside of China, where the deadly virus has claimed the lives of a reported 2,771, world health leaders are preparing for a global pandemic that will provide a tsunami of health information for use by governments, world health agencies, and researchers, to hopefully control the future spread of the disease, develop va...

The Trump Administration has grand plans to make healthcare prices more transparent, hoping a little bit of light will help lower the high costs of U.S. healthcare. In new regulations, the administration is requiring hospitals to disclose, for the first time, the prices they negotiated with health insurers for a wide range of services, as well as the prices they charge patients who are paying with...

Dr. Nichols, who is authoring an exclusive four-part series on healthcare data for ICD10monitor, reports on the crucial search for reliable health information, noting that without it, all stakeholders are at significant financial and/or personal health risks. Dr. Moffic, one of America’s foremost psychiatrists, reports on the intriguing subject of solastalgia – the rising world temperature, and it...

While facilities and practices are concentrating on making critical changes in 2020 and 2021, it is important not to lose focus on the basics of correct coding. CPT® and ICD-10-CM coding errors can cost healthcare providers millions of dollars in lost revenue, but also, those errors can trigger compliance issues that could lead to audits. Reporting our lead story during this edition of Talk Ten Tu...

The release of the fiscal year (FY) 2020 Official Guidelines for Coding and Reporting (OCG) has resulted in confusion and apprehension surrounding the intent of the new guideline related to the new ICD-10-CM codes for pressure-induced deep-tissue damage or deep-tissue pressure injury (L89.-6). The ambiguity stems from what appears to be conflicting advice found within the coding guidelines (I.C.12...

With prior authorization (PA) posing a significant pain point for healthcare providers and a major headache for most practices, Talk Ten Tuesdays asked Terry Fletcher to report on this troubling issue, especially in light of the WEDI survey results posted this week, revealing that 84 percent of providers reported that the number of medical services requiring PA has increased. The PA process, heavi...

Talk Ten Tuesdays is continuing its reporting on the unprecedented changes occurring this decade in the world of healthcare coding. Coders and health information management (HIM) professionals need to retool in order to meet new challenges brought about by artificial intelligence, as well as by social and political changes already underway. With profound healthcare upheaval taking place here and g...

The coding world in 2020 will be a new landscape of challenges for coders as well as health information management (HIM) professionals. And to help you and your team prepare for what lies ahead in the New Year, Gloryanne Bryant, a well-known, national coding and HIM leader, returns to the Talk Ten Tuesdays broadcast with her report on six major issues confronting coders this year and beyond. The p...

In the true holiday spirit of giving, during this edition of Talk Ten Tuesdays weekly broadcast will provide you and your team with some free advice on how to avoid claim denials – especially if you don’t have a robust claim denials management process. Unfortunately, the majority of healthcare organizations encounter claim denials on a regular basis, often habitually. Though some claim denials may...

There was a time when the coin of the realm in the world of coding was knowledge of complications or comorbidities (CCs) and major complications or comorbidities (MCCs). But 10 years later, the industry has changed rapidly, and to avoid going the way of the dinosaur, coders today need to embrace all patients’ refined diagnosis-related groups (APR-DRGs) and hierarchical condition categories (HCCs)....

As we conclude our month-long Talk Ten Tuesdays series, “Ten Going on Eleven,” we do so with a special appearance by Valerie Watzlaf, board president and chair of the American Health Information Management Association (AHIMA). Valerie, vice chair of education and associate professor within the Department of Health Information Management in the School of Health and Rehabilitation Sciences at the Un...

Exclusive reporting on ICD-11 and the need for early preparation for the new code set continues at ICD10monitor and Talk Ten Tuesdays. Among those skills that will need to be honed is hierarchical classification category (HCC) coding. HCCs thrive on specificity. Although it was thought that ICD-10 delivered the ultimate level of specificity, ICD-11 is expected to surpass ICD-10 in that area. But H...

Data mining is the next frontier in healthcare – and it’s here. The creation of revenue management and data management educational tracks in health information technology (HIT) associate degree programs, plus the use of artificial intelligence (AI) to assign ICD-11 codes, means that data mining skills are a must-have for coding specialists, requiring extensive education. To help assist this major...

ICD-11 is on track to arrive here in the U.S. sooner than most expected – 2022. In fact, global experts convened in Switzerland to create a roadmap to advance the digital health ecosystem. For the very latest update on ICD-11, the World Health Organization’s (WHO’s) Robert Jakob, MD, team leader of classifications and terminologies (ICD, ICF, ICHI), is today's Talk Ten Tuesdays special guest....

“In the hospital setting, we see multiple insurance denials on a weekly basis,” Lamon Willis recently wrote in an article for ICD10monitor. “Teams of people route them to various departments for analysis and review. I have staff members who review the APC and/or DRG, along with coding criteria, to determine if we have properly fulfilled our duties as coders and to support the appeals process for t...