My Wish List for HIMSS15: Bring Documentation into the Health IT Conversation

For the past two years, I have been fortunate to attend the HIMSS Annual Conference & Exhibition in both New Orleans and Orlando. HIMSS puts on a massive event for about 38,000 people, so it’s definitely a great place to learn and network around the newest technologies, trends, and solutions in healthcare information technology. HIMSS15 kicks off in Chicago on April 12, and although I am unable to attend this year, I’ve been thinking about the conversations and ideas I hope will be generated by the organizers, presenters and attendees. Continue reading

Three Strategies to Fund Sustainable State IT Data Projects

Escalating healthcare costs have persuaded many states to redesign their Medicaid payment systems. Most of them are also developing innovative uses of their client data to help reduce Medicaid costs and improve health. The projects range from alternative payment models to all-payer claims databases, often funded by grants. Continue reading

Observation Services: Documenting Medical Necessity (Part Two)

In last week’s blog, I discussed observation services and private payer requirements. Now let’s take a look at CMS requirements which are a bit different. Observation is expected to be used when the physician presumes the patient will need less than 48 hours of care and the time in the hospital does not cross two midnights. Specifically, CMS says “The physician’s ‘expectation …should be based on such complex medical factors as patient history and comorbidities, the severity of signs and symptoms, current medical needs, and the risk of an adverse event.’” The CMS clinical and time expectations are similar to BCBS of NC. Continue reading

Observation Services: Documenting Medical Necessity (Part One)

I shudder to think about the compliance quicksand surrounding observation services. Regardless, I’m going to attempt to explain how to document medical necessity for observation services (OBS). Fortunately – or unfortunately – depending on how you look at it, documentation requirements for medical necessity for OBS is not the same for all payers. Continue reading

To Readmit or Not Readmit…Is That the Question?

As many of us in health care realize, sometimes it is just not possible to keep patients out of the hospital! All of our best strategies are in some cases not used, or in others, did not work. So how do we keep patients out of the hospital? Per chance we are putting the cart before the horse. Let me explain. Continue reading

SGR and ICD-10: Time for Spring Cleaning

It’s that time of year again. For people not working in the healthcare industry, it’s time for flowers to start blooming, windows to be opened to fresh air, swimsuit shopping and, even though we had a short-lived blizzard in Colorado yesterday, I’m ready for spring! Let the spring cleaning begin. However, there is the painful memory of last year, when ICD-10 was delayed “at least until October 1, 2015” via the SGR repeal bill, also known as the doc fix bill. I remember exactly where I was when I heard the news. Continue reading

HIMagine That! Codes and Kangaroos Down Under

Donna: Hello from Down Under where they have been using ICD-10 since 1999!

Sue: Hi! How has your work and your visit been going? Have you learned any ICD-10 tips worth sharing? Continue reading

Finding Value at the 3M Client Experience Summit

The 3M Client Experience Summit is less than two months away, May 5 – 7 in Salt Lake City. As I talk with customers about it, I’ve settled into a quick list of reasons why I find it valuable for myself and clients. If you work for a healthcare provider that licenses 3M software, pay attention. This is why you might want to attend the 2015 summit, too. Continue reading

How Can You Predict a Patient’s Risk for Heart Failure? Ask Them.

A critical task in population health management is identifying individuals at risk for bad outcomes and providing intervention to reduce that risk. Claims-based algorithms identify prospective risk,¹ but people without a claims history present a problem as payment continues to move toward value-based purchasing. Rather than waiting for claims, we can ask people questions that unmask significant risk. Patient-reported data tells us, in real time, a person’s risks and hands clinicians an opportunity to address those risks and change outcomes. Continue reading

Do You have Questions About Edits 71 and 77?

I live in the Salt Lake City area, but last week I ventured east for the public Hospital Outpatient Payment (HOP) Panel meeting at CMS. As I listened to the testimony, I thought about some of the emails I have received about OCE edits 71 (Claim Lacks required device code) and 77 (Claim Lacks allowed procedure code). I have been asked a number of questions about these edits along with requests to talk to CMS to see if they would reinstate them, or as a last resort, have 3M create similar edits. Continue reading