Medicare

Analyzing Eight Months of ICD-10

Article by Mary Butler. This article was originally published on the Journal of AHIMA website on June, 2016 and is republished here with permission. Teachers know there are two kinds of students. Student A studies and does their assigned reading throughout the whole semester, earning extra credit where they can. When the final exam rolls up, they’re…

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DEVELOPING: CMS Releases 2017 ICD-10-PCS Codes

By Laurie M. Johnson, MS, RHIA, CPC-H, FAHIMA for ICD10 monitor The Centers for Medicare and Medicaid Services (CMS) released the 2017 ICD-10-PCS codes as well as other supporting documentation on Thursday. Before you get excited, the 2017 ICD-10-CM codes have not been released yet. The additional supporting documentation includes the 2017 ICD-10-PCS Official Coding and Reporting…

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Hospital Pays $2.2 Million HIPAA Penalty for Reality Show Participation

Article by Mary Butler. This article was originally published on the Journal of AHIMA website on May 18, 2016 and is republished here with permission. New York Presbyterian Hospital was slapped with a $2.2 million fine for allowing a network reality show film the death of a trauma patient without seeking permission from the patient’s family. The…

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Healthcare CEO Faces Life in Prison for Fraud That Led to 2 Patient Deaths

By Ayla Ellison for Becker’s Hospital Review The CEO and co-owner of a Maryland diagnostics company is facing life in prison after a federal jury convicted him of two counts of healthcare fraud that resulted in death, according to the Department of Justice. On Wednesday, a federal jury found 67-year-old Rafael Chikvashvili, PhD, guilty of healthcare…

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Whistle-Blower Claims 33 Hospitals Submitted More Than $1B in Fictitious Costs

By Ayla Ellison for Becker’s Hospital Review A whistle-blower recently defended the viability of a federal complaint he filed, saying 33 hospitals in North Carolina, South Carolina and Georgia benefited from fictitious cost report claims submitted to Medicare and Medicaid. The whistle-blower, Joseph Vincoli, first brought suit against Charlotte, N.C.-based Carolinas HealthCare System and North Carolina…

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Grappling With the End of Physician ICD-10 Coding Grace Period

Article by Mary Butler. This article was originally published on the Journal of AHIMA website on May 19, 2016 and is republished here with permission. October 1, 2016, will mark the end of a one-year “grace period” that allowed unspecified ICD-10-CM codes on certain physician Medicare claims. The grace period was a joint initiative between the Centers…

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Highmark to Pay More for Better Diagnostic Documentation

By Joseph Goedert for Health Data Management Highmark Inc., a Blues plan serving Pennsylvania, Delaware and West Virginia, is giving physicians a financial incentive to increase documentation of diagnostic codes in the electronic health record of patients insured under Medicare Advantage or health insurance exchange programs. Too often, physicians enter a core diagnosis following a…

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HHS Awards $260 Million to Health Centers Nationwide

By HMT Mag for Health Management Technology HHS Secretary Sylvia M. Burwell announced over $260 million in funding to 290 health centers in 45 states, the District of Columbia, and Puerto Rico for facility renovation, expansion, or construction. Health centers will use this funding to increase their patient capacity and to provide additional comprehensive primary…

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CMS Drops Two-Midnight Rule’s Inpatient Payment Cuts

By Virgil Dickson for Modern Healthcare The CMS will not continue to impose an inpatient payment cut to hospitals under the two-midnight rule following ongoing industry criticism and a legal challenge. It will provide a onetime bump to hospitals to offset the cuts. The agency imposed the cut because it estimated the two midnight policy would…

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ICD-10 to Get 5,500 New Codes, Including Ones for Face, Hand Transplants, CMS Says

By Susan Morse for Healthcare IT News CMS said it plans to add about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the coding system. On Oct. 1, the Centers for Medicare and Medicaid Services will add another 5,500 codes to the ICD-10 diagnostic library, officials announced in a March 9 meeting. The addition will…

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