Author Archives: Barbara Aubry

Documenting medical necessity

CMS recently released a new National Coverage Determination (NCD), which was implemented on January 4. NCD 210.14 titled “Lung Cancer Screening with Low Dose Computed Tomography” is good news and expands the preventive services CMS offers its beneficiaries. Continue reading

CMS releases clarifications regarding NCDs and LCDs

I feel a bit like January, 2000 – much ado about little. Looks like (so far) ICD-10 is a go. I’m not saying there haven’t been bumps in the road, or that there are no obstacles we have yet to recognize, but I think I can say, “so-far-so good.” Something I have spent the last few years deeply involved with is the translation of the National Coverage Determinations (NCDs) to ICD-10. On November 20, 2015, CMS released information regarding feedback on some of the NCD translations and issues discovered in some of the LCD policy translations prepared by the MACs. Continue reading

Focus on patient preferences

I am a Registered Nurse. I won’t admit to how many years’ experience I have, but suffice to say, this is not my first rodeo. I had to chuckle when I read the October 29, 2015 news release from CMS titled, “Discharge Planning Proposed Rule Focuses on Patient Preferences.”

For those who are not case managers, and I know there are a ton of you out there, “discharge planning” is the term we apply to the act of planning a patient’s discharge as soon as they are admitted to the hospital or other facility. Continue reading

Healthcare compliance more important than ever

On September 10, 2015, while most of us in health care were deeply involved in ICD-10 preparation, the Department of Justice (DOJ) released a ruling that will significantly impact every healthcare provider – facility and professional alike. The DOJ announced that no civil or criminal settlements will be made absent the names of the individuals involved. The DOJ will not allow culpable individuals to avoid punishment when it settles cases. Continue reading

More changes contemplated for short stays

As we all focus on the looming deadline for the ICD-10 go-live, CMS is quietly floating more changes to short stay requirements.

CMS reiterated its goals of “respecting the judgment of physicians, supporting high quality care for beneficiaries, providing clear guidelines for hospitals and doctors and incentivizing efficient care to protect the Medicare trust funds.” So, what’s new? Continue reading

Attention Physicians and Coders: CMS’ Advanced Analytics Paying Off – Big Time

My mother taught me that it’s impolite to say “I told you so.” My daughter tells me I’m bossy and health care compliance is pretty dry (she’s trying not to be impolite and say “boring”) but when millions of dollars are connected, it’s much more interesting and news worthy.

So, sorry Mom, but I told you so and I’ve been telling you since I began blogging. And yes, big brother and his whole family are watching. Continue reading

CMS Clarifies “ICD-10 Families” and Offers Guidance on ICD-10 Flexibilities

The latest from CMS and AMA on July 6, 2015 is a bit confusing – I agree. But a clarification was released yesterday.

In case you missed the July 6, 2015 release, CMS and the AMA announced an effort to work together to help Part B providers under the Physician Fee Schedule prepare for ICD-10. CMS recognized some physician and other professional providers need additional help. To assist in the transition, CMS announced “Medicare review contractors will not deny physician or other practitioner claims billed under Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Continue reading

Physicians and Coders: No More Unspecified Care

The team I work with has done an enormous amount of work translating medical necessity policies from ICD-9 to ICD-10. And we have had many discussions regarding the codes that represent “unspecified” care in ICD-10. Should they stay in the translations – or go? Is ICD-10 specific enough to cover all care and coding contingencies now?

Unspecified Defined

An internet search (don’t you love being able to search so easily?) revealed:

Un-spec-i-fied: (adjective) meaning “not stated clearly or exactly”. Synonyms: unnamed, unstated, unidentified, undesignated, undefined, unfixed, undecided, undetermined, uncertain… Continue reading

Millions Claimed by Lost Physicians and Coders

There was only one time in my life that I literally did not know where I was. I had just moved to Alexandria, Virginia and took a wrong turn off the Beltway. I didn’t know which state I was in until I asked at a gas station. The station attendant thought I was crazy of course, but when I explained my predicament he laughed and told me that I was actually in Maryland. Since this happened pre-GPS, he also gave me directions to get back to Virginia – but, as I said, that only happened once. Continue reading

New Outpatient Evaluation & Management Codes?

On April 17 the American Academy of Family Practitioners (AAFP) reported that a coalition of providers sent a letter to CMS proposing to “redefine and reevaluate” outpatient E&M service codes. These providers include:

  • American Academy of Allergy, Asthma and Immunology
  • American Academy of Neurology
  • American College of Allergy, Asthma and Immunology
  • American College of Rheumatology
  • American Society of Hematology
  • American Psychiatric Association
  • Endocrine Society
  • Joint Council of Allergy, Asthma and Immunology on behalf of the Advocacy Council of the ACAAI
  • Society of General Internal Medicine

Continue reading