Clinical Documentation Improvement

News & Important Information:

According to the OIG- Insufficient documentation accounted for 87.8 percent of improper payments for surgical dressings, see MLN: PROVIDER COMPLIANCE TIPS FOR SURGICAL DRESSINGS

Payment Adjustment Rules for Multiple Procedures and CCI Edits - Find-A-Code Spotlight Articles

Clinical documentation improvement (CDI) is the process of producing detailed medical documentation accurately representing a patient's clinical status into coded data. CDI is used to provide information to all members of a patient's care team, facilitate improved patient care, disease tacking, outcomes and medical  research , maximize claims reimbursement, and improve data collection and analysis.

Check Out Find-A-Code's Tools & Resources

Diagnosis Related Group (DRG) Codes

Find-A-Code's DRG Information Page

Provider Documentation Guides™ (PDGs)

Help providers understand what needs to be documented

AHA Coding Clinic®

Search the AHA Coding Clinic® Articles by Keywords

NCDs/LCDs/Articles

Search NCDs, LCDs, and Articles for Documentation Requirements, Limitations of Coverage, and/or Medical Necessity.

MS-DRG Grouper

Quickly calculate the correct DRG based on submitted ICD-10-CM and ICD-10-PCS codes

HCC Code Listing

Review CMS, ESRD, HHS and Rx HCCs

HCC Risk Calculator

Easily calculate HCC risk scores based on diagnoses and other key factors

Berenson-Eggers Type of Service (BETOS) Codes

Review the BETOS code listing

Check-A-List

DME Documentation

Scrub-A-Claim

Eliminate Claim Errors

Code-A-Note

Code Suggestion Tool

NCCI Editors - Validate CCI Edits (Prevent Denials)

See Errors and Warnings, prior to claim submission

E/M Code Calculator

These E/M calculators will help ensure providers are selecting the proper E/M codes.

Additional Links and Resources

CDE's

CMS- Clinical Data Elements

Select the title to see a summary and a link to the full article.

Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

|

Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?

Read the article →

ICD-10-CM Cracks Down on the Use of "Unspecified" in the 2021 Official Guidelines

|

We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.

Read the article →

Watch out for New ICD-10-CM Codes

|

New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.

Read the article →

​​Polysomnography Services Under OIG Scrutiny

|

The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?

Read the article →

Managed Care Organizations Use CMS Tools to Identify Outliers

|

Managed Care Organizations (MCOs) include risk-adjusted plans whose funding is based on the health status of their beneficiaries. Government-funded MCOs use CMS information to search for suspected cases of fraud and abuse.

Read the article →

OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment

|

As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.

Read the article →

How Reporting E/M Based on Time May Lose Money

|

Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...

Read the article →

How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment

|

The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.

Read the article →

Cross-A-Code Instructions in Find-A-Code

|

Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.

Read the article →

Medicare Improper Payment Report for Chiropractic (2019)

|

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ...

Read the article →

Medicare Improper Payment Report for Behavioral Health Services (2019)

|

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report, behavioral health services have some of the highest Part ...

Read the article →

Medicare Improper Payment Report (2019)

|

The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July ...

Read the article →

OIG Report Highlights Need to Understand Guidelines

|

A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.

Read the article →

ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting

|

The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).  The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.  ICD-10-CM Official Coding Guidelines - ...

Read the article →

Special COVID Laboratory Specimen Coding Information

|

With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.

Read the article →

Dismal OIG Report on Telemedicine

|

Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

Read the article →

Medicare Announces Coverage of Acupuncture Services

|

On January 21, 2020, a CMS Newsroom press-release read, This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...

Read the article →

Show older articles ↓


There are more articles. View all articles...

View articles for the current subject by subtopic:




Access to this feature is available in the following products:
  • HCC Plus
  • Find-A-Code Professional
  • Find-A-Code Facility Base




   (There are no webinars at this time, please check back later.)
ACA Clarifies Aetna PolicyAetna Physical Therapy PolicyAmerican College of Radiology Practice Parameter for Communication of Diagnostic Imaging FindingsCan I Perform 2 Untimed Codes at the Same Time?Chiropractic Software-Generated Documentation by NoridianCMS Meaningful Use Registration and Attestation WebsiteCMS-Novitas Solutions: E/M Documentation Auditor's InstructionsCMS-Novitas Solutions: Specialty Exam: CardiovascularCMS-Novitas Solutions: Specialty Exam: DermatologyCMS-Novitas Solutions: Specialty Exam: Ears, Nose and ThroatCMS-Novitas Solutions: Specialty Exam: EyesCMS-Novitas Solutions: Specialty Exam: Genitourinary (Female)CMS-Novitas Solutions: Specialty Exam: Genitourinary (Male)CMS-Novitas Solutions: Specialty Exam: Hematologic/Lymphatic/Immunologic ExaminationCMS-Novitas Solutions: Specialty Exam: MusculoskeletalCMS-Novitas Solutions: Specialty Exam: NeurologyCMS-Novitas Solutions: Specialty Exam: RespiratoryCoding and Billing WorkshopsCoding_Changes_2014Complaince Program Guidance for Third-Party Medical Billing CompaniesCompliance Program Guidance for Ambulance SuppliersCompliance Program Guidance for Clinical LaboratoriesCompliance Program Guidance for Home Health AgenciesCompliance Program Guidance for HospicesCompliance Program Guidance for HospitalsCompliance Program Guidance for Individual and Small Group Physician PracticesCompliance Program Guidance for Medicare+Choice OrganizationsCompliance Program Guidance for Nursing FacilitiesCompliance Program Guidance for Pharmaceutical ManufacturersCompliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply IndustryCR 5550 Clarification - Signature Requirements by CMSDetails about EHR Incentive ProgramDocumentation Topics PageEHR Topics PageGastro_ArticleGeriatricHealth Behavior Assessment and Intervention Billing and Coding Guide by the APAHHS, Justice Department warn hospitals on EHR-related payment fraudHHS/CMS Letter Regarding Cloning RecordsHIPAA regulations and sign-in sheets - by HHSHome Health Billing FAQsImpairment Rating GuidesInappropriate Medicare Payments for Chiropractic Services Report - by the OIGInjury and Illness Recordkeeping RequirementsMedicare Advantage Plans: Cost Sharing LimitsMedicare Documentation Job Aid for Doctors of Chiropractic — MLNMedlinePlusNew Modifiers to Identify Occupational Therapy (OT) and Physical Therapy (PT) Services Provided by a Therapy AssistantNoridian Documentation ChecklistsNoridian Review of A5500 (Therapeutic Shoes)OIG Compliance Program for Individual and Small Group Physician PracticesOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOIG Issues Renewed Focus on Chiropractic ServicesPressure Ulcer GuidelinesProperly Appealing CCI Edit Denials - by ACAProvider Compliance Tips for Diabetic Test StripsProvider Compliance Tips for Hospital Beds and AccessoriesProvider Compliance Tips for Infusion Pumps and Related DrugsProvider Compliance Tips for Laboratory Tests - Blood CountsQuality Payment ProgramRisk classification based on the comprehensive foot examination by American Diabetes AssociationScreening Pap Tests and Pelvic Examinations by CMSSecurity Risk Assessment WizardSonomaSubjective/Objective Findings Necessitating CareSupplemental Compliance Program Guidance for HospitalsSupplemental Compliance Program Guide for Nursing FacilitiesThe Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1 BThe One-Minute Spinal Outcome Measure




   (There are no podcasts at this time, please check back later.)



suggest a resource

If you know of a resource that should be included here (links, data, etc.) please contact us.

free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.