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Revisiting Unrelated Surgical Procedures (MS-DRGs 981-989)

Author: Wilson, Donna D

Source: CodeWrite

Publication Date: February 2016



Make a fresh start in the new year by revamping coding compliance plans to include a second level review of all claims that group into MS-DRGs 981-989 (Operating Room Procedure/Unrelated to Principal Diagnosis). Historically, MS-DRGs 981-989 have been "low hanging fruit" for outside audito....

IPPS — Final Rule Fiscal Year 2016

Author: Wilson, Donna D

Source: CodeWrite

Publication Date: October 2015



Like clockwork, the Centers for Medicare and Medicaid Services (CMS) published the Inpatient Prospective Payment System (IPPS) final rule in the August 17, 2015 Federal Register. These changes to the regulations apply to approximately 3,400 acute care hospitals and will go into effect Octo....

Recovery Audit Program Changes

Author: Wilson, Donna D

Source: CodeWrite

Publication Date: February 2015



Editor's note: The Centers for Medicare and Medicaid Services (CMS) has delayed the commencement of work under the Recovery Audit contract for durable medical equipment (DME), home health (HH), and hospice reviews. For more information and further updates on this new development, please s....

New Changes De-Spookify Modifier -59

Author: Wilson, Donna D

Source: Journal of AHIMA - website

Publication Date: October 30, 2014



The proper application of modifier -59 (Distinct Procedural Service) has mystified many a coder. The Centers for Medicare and Medicaid Services (CMS) has recently indicated that modifier -59 is the most commonly used and abused of all the modifiers—mainly due to the fact that it is used to....

Managing Governmental Audits

Author: Wilson, Donna D

Source: AHIMA presentation

Publication Date: November 2012

This presentation defines governmental audits, reviews record requests and limits, walks through the RAC discussion period and appeal deadlines, addresses managing the audit process, various tools to use in an audit, and appeal writing and discussions.

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