Author Archives: Donna Smith

The Impact of ICD-10 on Reimbursement: What’s Realistic?

HFMA Reg 2On a beautiful fall day in upstate New York, I joined a group of healthcare financial executives at the HFMA Region 2 Fall Institute. Meeting hot topics included change management, the CMS Two Midnight rule, big data, and Medicaid updates.

Attendees also learned about the impact of ICD-10 on reimbursement in my presentation “ICD-10: Determining the Realistic Reimbursement Impact on MS-DRGs and APR DRGs.” While ICD-10 may impact many areas of the revenue cycle after October 1, 2015, including the DNFB and cash flow, my presentation focused on analyzing the potential shift in reimbursement by comparing claims coded in ICD-9 and ICD-10. Continue reading

Concerned about Coder Agreement in ICD-10?

Results of some recent studies evaluating the percentage of coder agreement in ICD-10 both intrigued and concerned me. It was a topic of conversation at three national conferences I attended recently, during which several of the speakers addressed the topic.. One study identified was the HIMSS “ICD-10 National Pilot Program: Outcomes Report,” released in October, 2013, which details findings from 200 patient records coded by two independent ICD-10-CM/PCS AHIMA Approved Trainers. The average accuracy between the two coders was 63 percent. These results made me wonder if the study’s outcome was due to a lack of ICD-10 coding knowledge or something else. Continue reading

Documentation and Compliance Risk: Top Areas to Watch

As the country moves to automated record-keeping in health care, there are certain areas that need to be scrutinized prior to assigning codes for billing. Compliant coding is of utmost importance, not only for healthcare providers, but also for government auditors. While new technologies are being introduced daily, the government has warned that it will not tolerate providers who try to “game the system.”

The top areas that must be evaluated by providers in determining how to use technology include: Continue reading