Released earlier than usual, the fiscal year (FY) 2022 ICD-10-CM Official Guidelines for Coding and Reporting became available online Monday, July 12, and include instructions for assigning novel code U09.9 Post COVID-19 condition (found under Section I.C.1.g.1). Familiarize yourself with the following new and revised guidance, effective October 1, to ensure proper diagnosis coding and […]
Medical practices are leaving money on the table by under-coding. Are one or more of your physicians under-coding? Missing revenue? Or relying too much on COVID-related funding? These are valid questions, as medical practices are getting back to pre-pandemic levels of care and encounters. Under-coding in particular has been a topic of concern lately. As […]
Hospital groups are digesting the 863-page CY 2022 OPPS proposed rule, but many are already commenting on new hospital price transparency penalties and other policies. The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other policies. The […]
The Centers for Disease Control and Prevention (CDC) released the ICD-10-CM Official Coding and Reporting Guidelines for the 2022 fiscal year (FY) on July 12th. The latest edition comprises 115 pages, which marks an 11-page reduction compared to the FY 2021 version. These updated guidelines will come into effect for discharges and visits from October […]
Understanding the qualifying payment amount and the initial information on the independent dispute resolution process “should be a short-term priority for revenue cycle leaders and their teams,” says attorney Harvey Rochman. Earlier this month, the federal government released an interim final rule outlining certain provisions of the No Surprises Act (NSA), which is designed […]
“It really undermines what the physicians are doing at the point of care, and it’s bad policy,” says Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage. UnitedHealthcare’s attempt to “Monday morning quarterback” emergency room visits by retroactively denying emergency claims is not only likely a violation of the prudent layperson standard, […]
Five tips to ensure better documentation and, along with it, better patient care and improved reimbursement. Providers and coders need a cooperative relationship, working toward a common goal of complete coding and positive reimbursement results, as supported by medical documentation. Here are five tips to ensure better documentation and, along with it, better patient care […]
New codes are effective Oct. 1, 2021. Highly anticipated, the fiscal year 2022 ICD-10-CM codes have been released by the Centers for Disease Control and Prevention (CDC), although still pending are the 2022 Official Coding and Reporting Guidelines which were not included in the package of new codes. We are still waiting for the release […]
The Supreme Court’s decision in California v Texas ended one lawsuit against the Affordable Care Act but may have left room for future legal action. Since the Supreme Court dismissed California v Texas on June 17, payers and healthcare leaders have vocalized their support for the decision, their readiness to continue building on the Affordable […]
The pandemic has only made the trend worse, as 33% of hospital executives report average claims denial rates of 10% or more. Hospital claim denial rates have hit new highs, with a 20% increase in those rates over the past five years, suggesting that better claims denial management processes are necessary, finds a new […]










