RMC’s Blog
Those Pesky Z Codes: The When, How and Why
Chapter 21 in ICD-10-CM contains our “Z” codes. Z codes (other reasons for healthcare encounters) may be assigned as appropriate to further explain the reasons for presenting for healthcare services, including transfers between healthcare facilities, or provide...
Walking the Tightrope in HCC Coding
The “coding” for HCCs (Hierarchical Condition Categories) is not for the faint of heart. At RMC, we have been in the risk adjustment HCC arena (auditing, coding and educating) since 2006. As an outsider or non-coder, looking in, it would appear to be so simple, BUT,...
The OIG Focus on Clinical Coding
The last 12-18 months has brought the healthcare industry many audit reports from the Office of Inspective General (OIG). These reports are always an important part of every Compliance Program and the related audit and educational activities. Certainly, for Health...
Coding Uncertain Diagnosis in the Pro Fee Setting
As coders we are often torn when it comes to coding a diagnosis when the provider’s documentation isn’t perfectly clear. It may sound elementary, but we must go back to the Official Coding Guidelines and stick to those to ensure we are reporting the correct diagnosis...
2022 OIG Work Plan: Balancing a focus on overall compliance and the public health emergency
What another crazy year, huh?! In 2021, the OIG continued to publish its work plan with monthly updates including OIG audits and evaluations for the fiscal year and beyond. Although the COVID-19 pandemic continues on, healthcare operations and government oversight...
April 2022 brings new COVID-19 CM and PCS Codes
When the final rule for the FY2022 Inpatient Prospective Payment System (IPPS) came out, it included the statement that we will now have clinical coding updates twice a year for ICD-10-CM and ICD-10-PCS, once in April and the usual large update in October. Keeping...
Medicare Part C Improper Payment Measurement
The Improper Payment Measurement or IPM provides statistical data on parts of the Medicare programs and reports overpayments and underpayments. The Medicare Part C beneficiary-level of payment errors from a given year is included and certainly is something to keep an...
OIG MA DX Audit Report – UPMC Overpaid
Another Office of Inspector General (OIG) audit report which targets Medicare Advantage (MA) risk adjustment (RA) diagnoses has been released. This November audit report was focused on University of Pittsburg Medical Center (UPMC) Health Plan, Inc, and “high-risk”...
FY2022 Physician Fee Schedule Is Released
November 2nd, 2021, the Centers for Medicare, and Medicaid Services (CMS) released their 2022 Physician Fee Schedule (PFS) final rule, which is 2,414 pages in length. Included in this policy ruling was also some other Medicare Part B issues. The PFS rule making is...
OPPS FY2022 Final Rule – Overview
The Hospital Outpatient Prospective Payment System (OPPS) Final Rule for Fiscal Year 2022 has been released by the Centers for Medicare and Medicaid Services (CMS). Included in the 1394 page OPPS final rule announcement that came on 11/2/2021 was the 2022 payment...