The Burden of Quality Reporting Revisited

A new report showed health systems spend nearly $39 billion a year on administrative activities related to regulatory compliance, according to a study released today by the AHA (American Hospital Association). The average hospital spends $7.6 million annually to...

Building a Compliance Program: Where Do I Start?

If you are new to compliance or new to building a compliance program, you may be asking yourself “where do I start?” As an educator and compliance professional, I’ve heard this question many times and even asked it myself. Even those who have been compliance officers...

HURRICANE HARVEY: How to help and where to donate…

Our hearts, thoughts and prayers are with our friends in Texas affected by Hurricane Harvey.  The aftermath of Harvey has overwhelmed Houston and the surrounding areas with much heartache, loss and devastation.  Many of us feel the urge to lend a helping hand, here...

The Importance of Auditing and Follow-up – points to ponder

As a compliance professional, auditing and monitoring is a key component to an effective compliance program. In the past I used to ask my students which of the Seven Elements of an Effective Compliance Program they felt was the most important (which is my first point,...

Coding Q&A with RMC: “tear” codes

CODING QUESTION: I would like to get some clarification on “tear” codes. I code a lot of ortho charts with rotator cuff tears, SLAP tears, meniscus tears etc. To avoid second guessing myself most of the time I am coding diagnosis codes on them, I would like to know...

Importance of Physician Engagement

The importance of physician acceptance for Clinical Documentation Improvement (CDI) efforts has been acknowledged since the inception of CDI programs. This is because the physician, alone, is ultimately the one responsible to establish a patient’s diagnosis. With a...

CODING Q&A with RMC: COMPLETED WEEKS OF GESTATION

CODING QUESTION: I am interpreting “40 completed weeks” as meaning the patient has to be through the 40th week. For example on code O48.0, would a statement from the provider that the patient is 6 days into their 40th week support coding O48.0 or would it need to...

Avoid Unnecessary CHF Queries with AHA Coding Clinic Guidance

Congestive heart failure (CHF) can now automatically be linked with hypertension according to Coding Clinic 1st Quarter 2017, Hypertension with Congestive Heart Failure, page 47.  Previously, hypertension had a presumed link with chronic kidney disease only. This...

When is PHI not PHI?

There continues to be a fair amount of confusion out there when health information is PHI and when it's PII.  This is true for a number of business associates as well as hybrid covered entities.  If the health information is generated by a covered entity doing a...