Compliance Question of the Week – General

Our hospital coding and CDI professionals have noticed an increase in length and redundancy in clinical documents since we have implemented the electronic health record (EHR). For ex., some physician progress notes have exploded from three lines in a paper record to three or more pages in an electronic record with information being copied and pasted. Do you have any suggestions on ways to deal with this problem?

One of our commercial insurers has denied our claims based on a “lack of clinical indicators.” We are assigning diagnostic codes based on the physician’s diagnostic statements. Should we be doing something else?

I have read that CMS will be developing “episode groups.” What are these?

For the Medicare program, what is the difference between fraud and abuse?

Is there a cost to the hospital if an implantable device that originally cost $20,000 fails and is replaced by a device that costs $16,000 and for which the manufacturer gives a credit of $16,000?

Can hospitals bill Medicare for the lowest level ER visit for patients who check into the ER and are “triaged” through a limited evaluation by a nurse but leave the ER before seeing a physician?

What is the purpose of the Medicare CERT program?

What is the purpose of the Medicare CERT program?

Can you provide any tips for conducting chart audits?

What is the deadline for hospitals to submit the Hospital IQR Program eCQM data to CMS?

Does Medicare reimburse telehealth services?

What is the performance period for the value modifier in 2017 and 2018?