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At Phoenix Medical, we believe the rapidly evolving marketplace requires new ways of thinking about managing patients. Whether those patients are at-risk or high-risk, we aim to transform previous hospital models and implement innovative, forward-thinking solutions for the benefit of each patient—and their provider.
Want to learn about our latest thoughts and ideas, straight from our team of experts? These are delivered monthly to your inbox or here for your review on the most pressing topics in care management.
My philosophy always has been to encourage providers to deliver excellent medical care, foster excellent documentation, have CDI specialists (CDISs) pick up the slack when needed, and ensure that coders accurately and compliantly code – and your reimbursement and quality metrics will fall where they belong in every model.
Providers shouldn’t be able to engage in fraud and abuse, and payors should have to pay for services legitimately rendered without throwing up roadblocks.
Pediatric experts have expressed their agreement: there is no such thing as sepsis without organ dysfunction.
Sepsis without organ dysfunction is…pneumonia or urinary tract infection or cellulitis. It doesn’t belong in the sepsis DRG, and I am going to predict that the OIG is going to agree with me.
Consistent with the annual updates to account for changes in resource consumption, treatment patterns, and the clinical characteristics of patients, CMS is recognizing inadequate housing and housing instability as indicators of increased resource utilization in the acute inpatient hospital setting.
The Centers for Medicare & Medicaid Services (CMS) recently unveiled its proposed changes for the Inpatient Prospective Payment System (IPPS) for the 2025 fiscal year (FY).
Indeed, despite the comprehensive efforts of a multidisciplinary care team, including the involvement of case management personnel to orchestrate a “safe” discharge plan, the threat of potential litigation or adverse patient outcomes looms heavily within hospital settings.
Overall, these investments align with the Administration’s goals of improving healthcare access, addressing mental health challenges, and ensuring equitable care for all Americans.
Metrics like observation rate, denials rate, and case mix index (CMI), although interconnected, are frequently established with independent goals, further complicating the pursuit of comprehensive success.
These commitments collectively contribute to demonstrate comprehensive efforts and offer tangible solutions to tackle hunger, improve nutrition, and reduce health disparities.
Make sure clinical documentation integrity specialists are vigilant when reviewing records of patients with pneumonia, and query when indicated.
When a CDIS composes a query, they should be providing the provider with the clinical indicators they need to make a thoughtful, informed decision.
Almost two months into the 2024 Outpatient Prospective Payment System (OPPS), I thought I would provide some clarity regarding the new social determinants of health (SDoH) and supportive service codes that have been released – specifically, the SDoH assessment, community health integration, and principal illness integration.
A condition may be diagnosable, but not relevant if it does not impact the current encounter. A diagnosis is not codable if it is not documented in an appropriate format.
It has been brought to my attention that some payers are citing the American Hospital Association (AHA) Coding Clinic, pages 147-149 of the 2016 fourth-quarter edition, to justify using their own criteria as the basis for denials.
Since Jan. 1, 2023, practically speaking, all evaluation and management (E&M) service coding is based on medical decision-making or time. And some providers are not documenting time appropriately.
On February 8, CMS released a memorandum outlining new guidelines and permission to text patient information and patient orders to health care team members.
The Centers for Medicare & Medicaid Services (CMS) just released news that they will be working on a 10-year payment and care delivery model called the Transforming Maternal Health Model (TMaH).
I think this report confirms some of the information we have already seen in our hospitals and EDs: that our patients are increasingly more socially and medically complex.
Queries, whether placed by a CDI specialist or an AI solution, need to be compliant and cannot lead providers.
If your facility has not taken steps to ensure that Hierarchical Condition Category (HCC) diagnoses are properly validated, you are just asking to be the next victim in the OIG headlights.
As we step into the new year, the mix of social needs and healthcare will continue to demand our attention.
Today is it is estimated that more than 2 million women of childbearing age live in maternity care deserts, meaning they reside in counties that do not have obstetric care, many of them rural.