Talk Ten Tuesdays

Are there significant risks of potential fraud and abuse with Medicare Advantage (MA) by plans, vendors, and providers, with an emphasis on ICD-10-CM’s impact on Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) risk adjustment? Evidently, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) believes there are. Recent...

It’s all about the money. It’s not only getting paid, but also getting paid the right amount. Little wonder that this is first and foremost on every provider’s mind. Often, though, success or failure lies in the completion and details of medical notes taken. So, what’s the deal with medical notes? Why are notes so important, and why are they difficult for providers to complete? We’ve invited Kevin...

ICD10monitor correspondent Linda Holtzman, founder of Clarity Coding, will return to the Talk Ten Tuesdays (TTT) broadcast this coming Tuesday, March 7 to report on the activities at the Coordination & Maintenance Committee (C&M) meeting taking place from the headquarters of the Centers for Medicare & Medicaid Services (CMS). Holtzman, a longtime C&M observer, will bring her knowle...

We will conclude our month-long observance of American Heart Month on the Talk Ten Tuesdays weekly Internet radio broadcast with an upcoming guest appearance of Cardiologist Harry B. Peled, MD with St. Jude Medical Center in Fullerton, Calif. Last Tuesday, Dr. Mahesh Amin reported on the use of new protocols centered on high-sensitivity troponins for the diagnosis of type 2 myocardial infarction (...

Last year, the Food and Drug Administration (FDA) issued its approval of using new protocols centered on high-sensitivity troponins for the diagnosis of type 2 myocardial infarction (MI). Reporting our lead story during the next edition of Talk Ten Tuesdays will be Dr. Mahesh Amin, CV Service Line Medical Director for BayCare Health Systems in Clearwater, Fla., a board-certified cardiologist. This...

In continuing our observance of American Heart Month, during the next live edition of the Talk Ten Tuesdays live Internet radio broadcast we will zero in on the topic of coding and clinical documentation integrity (CDI) issues related to cardiovascular procedures – and, specifically, the importance of obtaining pre-authorizations for cardiology procedures. Obtaining cardiology procedure pre-author...

February is American Heart Month, a time to raise awareness of cardiovascular health and to shine the light on cardiac issues, especially myocardial infarction. Unfortunately, every year about 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds.  And that is why we invited the Chief Executive Officer for the Innova Revenue Group, Lidiya T...

Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Respiratory Therapy All Access Pass , and why it is an important product for healthcare professionals. 

As rural hospital closures continue to increase (136 have occurred between 2010 and 2021), health information management (HIM) and clinical documentation improvement (CDI) professionals have key roles in ensuring revenue integrity and optimization essential to sound operations and access.  Even so, small facilities, especially those operating independently, simply do not have the resources that la...

Who knew that when the venerable American Medical Association’s (AMA’s) combining two hospital encounter service types into one code set of inpatient/observation services – initial and subsequent – consternation would be the outcome. The confusion: what entity can actually bill an inpatient initial code, 99221-99223, and who must default to subsequent codes or report office and other outpatient co...

The term “DRG mismatches” is most often used to describe situations wherein the working diagnosis-related group (DRG) selected by the clinical documentation improvement specialist (CDIS) differs from the final coded DRG, signaling that the CDIS and the coder have arrived at different principal diagnoses. In other situations, a procedure may have been coded incorrectly by the CDI professional, caus...

Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Nuclear Medicine All Access Pass , and why it is an important product for healthcare professionals. 

Within the hospital setting, the term “mismatch” is most often used to describe a situation wherein the final working diagnosis-related group (DRG) selected by the clinical documentation improvement (CDISs) specialists from the final coded DRG. This can be due to many reasons. One of the most frequent reasons is that the CDI professional and coder have arrived at a different principal diagnosis. I...

Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Infusion & Injection All Access Pass , and why it is an important product for healthcare professionals. 

Telehealth is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state. When the public health emergency (PHE) was declared in March of 2020, most states, followed the federal exceptions under the 1135 CARES Act waivers, allowing, an out-of-state provider to render services via telemedicine in a state where th...

New codes. Old codes. Deleted codes. ICD-10 codes, evaluation and management (E&M) codes, and Z codes. It’s raining codes, and during the next live edition of Talk Ten Tuesdays, you’ll hear the very latest coding news – along with all you need to know to keep you performing at the top of your game. The live broadcast will also feature these other segments: CDI Report: Cheryl Ericson, a recogni...

Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore! In this episode, Mary goes over the Comprehensive Cardiology All Access Pass , and why it is an important product for healthcare professionals. 

Be sure to join us for the next live edition of Talk Ten Tuesdays, when Karen Bartrom, director of clinical integration and documentation at Cameron Memorial Hospital in Indiana, will report on how Z codes – the social determinants of health (SDoH) and ICD-10-CM codes – can reveal insights related to the health of a community. With the mapping of patient SDoH responses to Z-codes, valuable aggrega...

Will the United States experience another federal public health emergency (PHE) beyond Jan. 11, 2023? The U.S. Department of Health and Human Services (HHS) on Oct. 13 renewed the PHE for an additional 90 days. Meanwhile, states continue to wait for a 60-day termination warning, as HHS had promised earlier. Joining the broadcast during the next live edition of the popular Internet radio program Ta...

Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore! In today's episode, Mary explains the importance of Ultrasound Coder .  Listen in to find out why this textbook could be a great addition to add to your essential library.

Our exclusive series on patient safety indicators (PSIs), being produced by ICD10monitor and Talk Ten Tuesdays in association with ChristianaCare, will continue next week. During the next live edition of Talk Ten Tuesdays, Dr. Jennifer Brettler and Kimberly Seery, both from the Delaware-based health system, will give you on a close-up look at AHRQ Patient Safety Indicator 90 – Patient Safety and A...

Long-awaited and highly anticipated, the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule Final Rule for 2023 released this past week supports the expansion of access to behavioral health and cancer screening, while promoting health equity. The timing of this Final Rule brings to mind the loss of actor Chadwick Boseman of Black Panther fame. Boseman died in 2020,...

Much like urban legends, the recurring tales of Medicare Advantage (MA) plans being accused of manipulating diagnoses and denying care that otherwise would have been covered under traditional Medicare are gaining traction. They are now even being referred to as Medicare “Dis-Advantage” plans because of all the manipulation, much related to the fact that a MA patient is more expensive to the Medica...

Today is the very last day to comment on the recently posted industry practice brief titled Guidelines to Achieving a Compliant Query Practice, co-authored by the American Health Information Management Association (AHIMA) and the Association of Clinical Documentation Integrity Specialists (ACDIS). The updated brief was released on Oct. 10, 2022 and has been open for comments. During the next live...

It takes a village to raise a child, but it took an integrated, multi-discipled team approach to improve patient safety indicators (PSIs) at ChristianaCare – as you’ll learn more about on Tuesday, Oct. 18, during the next live edition of Talk Ten Tuesdays, the popular, long-running Internet radio program produced by ICD10monitor. In cooperation with ChristianaCare, Talk Ten Tuesdays and ICD10monit...