E/M Hot Topic: Telemedicine Update
Jeanie Heck, our Director of Education, begins our 2022 series of E/M Hot Topics with a discussion on Telemedicine. January’s Hot Topic provides an update from the CMS Final Rule as well as some reliable and reputable sources of information regarding telehealth.
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Jeanie Heck, our Director of Education, wraps up our E/M Hot Topic series for 2021 discussing the new 2022 Principal Care Management Services codes. In 2022, we will have three general categories of Care Management in our E/M section. The new PCM codes allow providers, qualified health care practitioners, and clinical staff to report a code(s) for the management of a single chronic condition.
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In our E/M Hot Topic discussions, we previously addressed the proper capture of Social Determinant of Health (SDOH) codes that can make a difference when determining the level of service for office visit codes. When used properly, they can impact the final MDM selection and subsequent reimbursement. In the November E/M Hot Topic, Jeanie Heck, our Director of Education, re-addresses this topic and reviews the new 2022 Chapter Specific Coding Guidelines for SDOH.
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In September’s E/M Hot Topic, Jeanie Heck, our Director of Education at Intellis, discusses telehealth. The 2022 Medicare Physician Fee Schedule Proposed Rule proposes that CMS allow some telehealth services to remain on the list until the end of 2023. This is intended to help determine if some of the services should be permanently added to the telehealth list following the COVID-19 PHE. During this presentation, Jeanie reviews some trustworthy and reliable sites to reference regarding telehealth.
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What is medical auditing?
Medical auditing is a thorough assessment of coding and billing information to validate accuracy and compliance within a healthcare organization. Most audits look at components of payer reimbursement processes to evaluate compliance with payer guidelines as well as federal and state regulations. The medical audit serves a vital role in a healthcare organization to ensure both risk mitigation and quality revenue cycle management.
What are the different types of medical audits?
There are two primary types of HIM medical audits. External audits identify compliance issues and areas in which to improve performance. External audits also determine education needs within an organization. Internal audits identify areas of weakness within the coding and billing staff so that focused education can be provided.
What are the benefits of a medical audit?
- Identify errors in coding and billing, including under coding, upcoding, unbundling, and incorrect use of modifiers.
- Identify fraudulent billing practices, both intentional and nonintentional
- To establish an effective quality assurance process to onboard new coders and providers
- To identify and provide focused education on missed opportunities and other areas of strengths and weaknesses
- To address areas of risk to prevent Risk Audit Contractor (RAC) or Risk Adjustment Data Validation (RADV) investigations
- To improve patient quality of care and help improve safety measures
Does Intellis hire medical auditors?
Yes! See our open positions here.
Does Intellis offer medical auditing services?
Yes! Check out Intellis IQ medical auditing services.
Intellis offers HIM and revenue cycle services. Please see our suite of Health Information Management Services and Revenue Cycle Solutions.
Intellis offers AHIMA-approved CEUs.
The Intellis IQ Education Center offers coding and clinical documentation continuing education approved by AHIMA. Please contact us if you have questions about our education platform and how it helps individuals and organizations.
What is medical coding?
Many people ask, “what is medical coding? Medical coding is the translation of healthcare diagnoses, procedures, medical equipment, and medical services into one of several universal coding classification systems using either alphanumeric or numeric codes. Codes for healthcare diagnoses and procedures reflect the information in patient medical record documentation to facilitate reimbursement and provide analysis of patient outcomes and research. Quality medical coding has many positive downstream effects. Studies show that accurate and complete coding for patients’ chronic diseases or conditions results in better care.
Medical coding is also critical to provider organizations working under risk-based contracts. Research indicates improved financial performance for the organization when patient treatments, services, and supplies are accurately and completely coded.
What do medical coders do?
A medical coder, also known as medical records and health information technician, is essentially a translator. The medical coder reviews patient files and translates procedures, diagnoses, and services into a code that healthcare providers and insurance companies utilize. Medical coders require critical thinking skills and a thorough knowledge of medical terminology, anatomy, pathophysiology, and pharmacology.
How long does it take to become a medical coder?
Though medical coding certification depends on several factors, the path to becoming a medical coder generally takes nine to two years to complete.
Does Intellis hire medical coders?
Yes! See our open positions here.
Does Intellis offer medical coding services?
Yes! Check out Intellis IQ coding services.
Intellis offers HIM and revenue cycle services. Please see our suite of Health Information Management Services.
Intellis offers AHIMA-approved CEUs medical coding.
The Intellis IQ Education Center offers coding and clinical documentation continuing education approved by AHIMA. Please contact us if you have questions about our education platform and how it helps individuals and organizations.
August 2021
In this month’s E/M Hot Topic, Jeanie Heck, our Director of Education, discusses “Drug Therapy Requiring Intensive Monitoring for Toxicity”. This falls under the HIGH level in our Risk element or level 5 (99205/99215). We now have a published definition for this in our 2021 CPT manual. This definition was further clarified by the CPT editorial panel in the Errata & Technical corrections document.
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“Here come the ‘chart police.’”
“Here come the ‘chart police.’” Every clinical documentation specialist (CDS) has heard it. “Chart police.” For those CDSs with a nursing background, it is often heard from those nurses they have worked alongside in the following ways:
(1) when discussing their new role
(2) while explaining their current role
(3) when attempting to recruit bedside nurses into the CDS career path.
How do we educate our bedside-loving peers about the value that their documentation brings to the final coded record? Show them.
Nurses love evidence.
It has been the foundation of nursing practice since Florence Nightingale demonstrated that good hygiene improved outcomes. Pull up a stand-alone encoder and show them the difference made by inclusion of wound staging or body mass index. Clinical documentation integrity is an obscure role to most nurses so take the opportunity to translate the language. Instead of demonstrating the MS-DRG, show the difference in severity of illness (SOI) and risk of mortality (ROM) when including their documentation. Interpreting SOI and ROM is a quicker soap box discussion than CC/MCC capture and translates clinically with almost no discussion.
ICD-10-CM Guidelines for Coding and Reporting allow us “few exceptions” to the rule that “code assignment is based on the documentation by patient’s provider” but, nurses need to know that their documentation often triggers CDSs to know that a query opportunity exists. Default templates utilized by providers may repeatedly explain that the patient is oriented, but night shift nurse documentation may paint a different picture of a sundowning patient. That picture is incredibly valuable to the accuracy of the coded record, particularly when the provider is documenting in progress notes when assessing the same patient during the day.
The remote world has done wonders for production but can put a strain on those opportunities to engage our healthcare partners and demonstrate value. Other ways to engage our nursing colleagues in understanding the value of their education: round with them during an onsite day, engage nursing management to become part of the nursing skills fairs (quality documentation is inarguably a skill), or seek out the opportunity to present to new nursing hires during orientation.
July 2021
In July’s E/M Hot Topic, Jeanie Heck, our Director of Education, discusses the new guidelines for Time and the Prolonged Time codes. The new 2021 E/M guidelines are significantly different from the way we previously used to account for Time. She also addresses the latest technical corrections regarding Time from the AMA’s webinar at the end of May and gives some documentation template examples to help educate your providers.
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June 2021
In this month’s E/M Hot Topic, Jeanie Heck, our Director of Education, addresses some of the items from the AMA webinar on May 25th regarding the Technical Corrections published on March 9th. Many of the gray areas from the technical corrections were addressed in the AMA webinar, and she discusses some of them in her presentation.
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May 2021
In this month’s E/M Hot Topic, Jeanie Heck, our Director of Education, discusses the 1st element of MDM: “Number and Complexity of Problem(s) Addressed.” She reviews the basics of this element and covers the associated 12 definitions related to “Problems Addressed.” Also included is an update to point-of-care (POC) testing which relates to the 2nd element of MDM: “Data.”
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