Coding, Compliance, and Revenue Cycle

The Healthcare Reimbursement Audit Toolkit provides guidance to HIM professionals on the identification of the internal support team, development of policies and procedures, establishment of an educational program and management of record requests, denials, and appeals. The toolkit highlights several governmental entities and governmental programs that focus on medical record audits.

The Physician Coding Toolkit provides multiple tools and resources to help providers and their staff successfully navigate challenges associated with accurate coded data. While information contained in this toolkit is comprehensive, it is not an all-inclusive list of resources. The content contained within this toolkit includes defining the various code sets used in provider practice; a summary of applicable coding guidelines; the impact of EHR documentation templates on coding compliance; introduction to typical coding workflows; best practices for coding audits; coder training; and more. The purpose of this toolkit is to help address and provide guidance on the most common coding-related issues found in provider practices today.

Computer-assisted coding or CAC (pronounced as “C-A-C”) is defined as the process for extracting and translating transcribed free-text data or computer-generated discrete data into codes (ICD-9-CM, ICD-10-CM/PCS and/or CPT/HCPCS) for billing and coding purposes.

This Practice Brief shares a solid approach for relying on claims data, analytics, benchmarking, and trending to predict future denials. In addition, suggestions are included for regular auditing, educating stakeholders, and monitoring regulatory and payor trends as necessary to minimize denials.

A current and accurate chargemaster is vital to any healthcare provider seeking proper reimbursement and a key indicator in a healthy revenue cycle.

This Toolkit discusses the appeals process to support a robust denials management program as well as ways to prevent denials from occurring.

The path to long-term successful denials prevention begins with a clear vision that is articulated in a formal denials prevention plan that includes stakeholders from across the healthcare continuum.

This Practice Brief provides risk adjustment documentation and coding best practices for the CMS-Hierarchical Condition Category (HCC) and the Department of Health and Human Services (HHS)-HCC models. Although each model has different applications, both rely on ICD-10-CM codes to risk adjust patients based on their health conditions.

This Practice Brief provides an overview of the DRG system and its evolution from a grouping system for utilization review purposes to a tool for reimbursement that also encompasses severity and risk measurement.

This Practice Brief will review the important ICD-10-CM and Current Procedural Terminology (CPT) coding guidelines for provider practices, as well as coding edits, tools, and templates in EHRs, the use of copy and paste, and more.

The Standards of Ethical Coding are important established guidelines for any coding professional and are based on the American Health Information Management Association's (AHIMA's) Code of Ethics. Both reflect expectations of professional conduct for coding professionals involved in diagnostic and/or procedural coding, data abstraction and related coding and/or data activities.

This Practice Brief provides an overview of the present on admission (POA) indicator as well as a checklist, information on POA guidelines, and documentation issues and tips to help organizations manage compliance with POA reporting requirements.

This Practice Brief outlines how healthcare organizations can best use the General Equivalence Mappings to facilitate translations to ICD-10-CM/PCS.

This Practice Brief identifies best practices that ensure clinical documentation remains accurate when leveraging data tools like EHR templates and prompts.

This Practice Brief provides education on ICD-10-CM as well as guidance for determining the correct principal diagnosis in long-term care facilities utilizing ICD-10-CM.

This practice brief will address the transition to ICD-10-CM/PCS, taking into account the three different levels of programs offered across a variety of academic settings. It will also offer best practices and recommendations to help streamline the overall transition for the educator and the student.