Tag Archives: icd-10

What We’re Reading – DOJ Launches Lawsuit Against Anthem for Risk Adjustment Fraud

As detailed in this article, Anthem is facing a lawsuit initiated by the Department of Justice (DOJ) for allegedly failing to remove erroneously submitted diagnoses from CMS’s database despite knowing that inconsistencies might be present. The health insurance carrier commissioned … Read Full Post

Tagged coding compliance, DOJ, icd-10, inflated risk score, mra, MRA program, risk adjusted reimbursement, risk adjustment, risk score |

Borderline Diagnoses

When a provider writes that a diagnosis is borderline, many coders will query the physician before coding. However, the ICD-10-CM Official Guidelines for Coding and Reporting states that borderline diagnoses are not considered uncertain and that there is no distinction … Read Full Post

Tagged borderline diabetes, borderline diagnosis, borderline schizophrenia, icd-10, query the physician |

What We’re Reading – Medical practice action plan: Overcome regulation overload

When you think of all the changes coming down the pike, it gets a little overwhelming, but don’t panic…. this article will ease some of the pressure and give you an action plan to make these transitions more bearable and/or … Read Full Post

Tagged coversion to ICD-10, ehr, electronic health records, icd-10, incentive programs for medicaid, incentive programs for medicare, meaningful use, medical practice action plan, regulation overload |

What We’re Reading – Four things doctors actually like about ICD-10

As you may already know, the largest complaint about the ICD-10 is that it is “complex and highly specific” with almost three times the number of codes than ICD-9. Although the 10th edition was introduced in 1992 and most developed … Read Full Post

Tagged icd-10, icd-10 conversion, icd-10 implementation, icd-10-cm, icd-9, icd-9-cm, International Classification of Diseases 10th Edition Clinical Modification, International Classification of Diseases 9th Edition Clinical Modification, transition to ICD-10 |

What We’re Reading – Feeling Better About ICD-10

With all of the negative talk going around about the ICD-10 conversion, the author of this article puts forth reasons why ICD-10 will prove to be a good thing…eventually. Updates technology and specificity. ICD-9 was developed in 1979 and is now … Read Full Post

Tagged coversion to ICD-10, ehr, icd-10, icd-10 conversion, icd-9, incentive programs, meaningful use |

What We’re Reading – Preparing for the ICD – 10 Transition

With only 37 months left before the healthcare world transitions to the ICD-10-CM, the author of this article suggests taking a systematic approach, in order to make the transition as smooth as possible. The key elements in making this transition … Read Full Post

Tagged coding & billing education, icd-10, icd-10 conversion, icd-10 training, icd-10-cm, icd-10-cm training, icd-10-cm transition, version 5010 |

How should I prepare for ICD-10?

From time to time, we hear about consultants scaring the daylights out of providers with horror stories about the transition to ICD-10. We disagree with that approach, although it’s important to have a healthy respect for any system that – … Read Full Post

Tagged aapc, diagnosis codes, documentation, healthcare consultants, icd-10, icd-10 conversion, icd-10-cm, icd-9, icd-9-cm, physician, providers |

What exactly is ICD-10?

ICD-10-CM (based on the International Classification of Diseases, 10th edition, Clinical Modification) is a standard set of codes used for conveying a patient’s clinical profile, if you will. Defined codes are used primarily to facilitate the gathering of data, its … Read Full Post

Tagged capitated providers, codes, diagnosis codes, documentation, icd-10, icd-10-cm, icd-9, icd-9-cm, international classification of diseases, physician |

How does provider reimbursement work?

There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4 & HCPCS codes. ICD-9-CM codes (soon to be replaced … Read Full Post

Tagged capitation, cpt codes, diagnosis, fee-for-service, icd-10, icd-9, procedure, provider, reimbursement |