RMC’s Blog
Medicare/Medicaid Underpayments a 75 Billion $ Reality per AHA Report
Across healthcare we focus on patient care and outcomes which is primary and foremost. In addition, we also focus on revenue and the revenue cycle. This will mean overpayments, which are compliance and financial risks and underpayments which are also both a compliance...
Remote Patient Monitoring . . . Codes to Help Capture These Medical Services
Remote Patient Monitoring or RPM is expanding and expanding quickly. This type of technology can assist with the remote assessment and monitoring of chronic conditions such as, Chronic Obstructive Pulmonary Disease (COPD), Heart Failure, Diabetes, Obesity,...
Retroactive Rate Adjustment for HCPCS Code G2025 for FQHC and RHC Claims
An issue was identified with the payment and cost sharing calculations on code G2025. Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Claims with HCPCS code G2025 have been mass adjusted to correct the payment...
Surviving Sepsis Campaign Continues – COVID-19 Clinical Guidelines in the ICU
Understanding the anatomy, physiology and disease process is a significant part of our daily work and competencies as Health Information Management (HIM) coding and Clinical Documentation Integrity (CDI) professionals. Thus, keeping on top of clinical information like...
COVID-19 Vaccination and CPT Coding Resources
We are all hearing and seeing news and information daily about the efforts to vaccinate the United States population against COVID-19 and progress is being made. With this medical effort there is a wealth of published guidance and facts that have been developed by the...
JAMA Released Study on DRG Trends
In a recent Journal of the American Medical Association (JAMA) a study on the highest reimbursed DRG (Diagnostic Related Group) trends from 2012 to 2016 was released. Medicare DRGs or Medicare Severity DRG (MS-DRGs) payment system includes the capture ICD-10-CM codes...
Social Determinants of Health (SDOH) are Underreported per Recent Study
A recent medical research publication titled: International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records; describes the underreporting of the Social...
USING CERT (Comprehensive Error Rate Testing) to Improve Coding Quality
The Centers for Medicare and Medicaid Services (CMS) has several programs they sponsor and/or support that target “improper payments”. One of those programs is Comprehensive Error Rate Testing or CERT. The purpose of CERT is to measure the Medicare Fee-For-Service...
AMA Releases Additional CPT for Johnson & Johnson COVID Vaccine
The American Medical Association (AMA) released on January 19th, 2021 new CPT codes for the COVID vaccine administration and the vaccine by Johnson and Johnson, which is still pending approval by the FDA. This COVID-19 vaccine was under development by Janssen...
The OIG Workplan and Building Your Coding Compliance Plan/Program
Each year the Office of Inspector General (OIG) publishes their healthcare workplan and this is an “opportunity” for us in review and learn from their areas of focus. The workplan can be viewed at: Work Plan | Office of Inspector General | U.S. Department of Health...