Talk Ten Tuesdays

Latest Episodes:

Reporting and Coding Separate Procedures: What Coders Need to Know Feb 26, 2019

Show notes

Many procedures in the CPT® codebook are designated "separate procedures," but that doesn't mean you can report those procedures "separately" in every case, according to nationally recognized professional coding expert Terry Fletcher, who returns to Talk Ten Tuesdays to offer insight into this topic.
Join Dr. Erica Remer and Dr. Juliet Ugarte Hopkins as they host the podcast, which also features these other segments:

The ICD-10 Coding Report: Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports on latest coding news.
News Desk: Timothy Powell, a compliance expert, and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
The Dunn Report: National health information management (HIM) expert and past American Health Information Management Association (AHIMA) President Rose Dunn returns to the podcast with a series on how HIM can play a role in other areas of the revenue cycle.
Guest Talk: Juliet Ugarte Hopkins, MD, CHCQM, physician advisor for case management, utilization, and clinical documentation at ProHealth Care, co-hosts the podcast along with Dr. Erica Remer, who is substituting for Talk Ten Tuesdays publisher and host Chuck Buck.

New Patient versus Established Patient: The Coder’s Dilemma Feb 12, 2019

Show notes

Knowing how to distinguish new patients from established patients, apart from ensuring that coding guidelines are being followed, enables you to be reimbursed for the additional work that new patient visits warrant. Moreover, in some cases, not distinguishing new patients from established patients can amount to shortchanging yourself, as you will learn during this edition of Talk Ten Tuesdays, when Terry Fletcher returns to the broadcast to report on evaluation and management (E&M) coding.
Other segments to be featured on the broadcast include:

The I 10 Coding Report: Yellow fever has been reported in the Americas, and this can be prevented – a warning for people who are planning trips to the Caribbean or Latin America. Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports on this new travel advisory.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
Dateline Washington: Talk Ten Tuesdays legislative analyst Rhonda Taller has the latest news coming out of Washington, D.C. Rhonda is a member of the HIMSS professional development committee.
Tuesday Focus: Sepsis 2 versus Sepsis 3 The Healthcare Association of New York State (HANYS) and Greater New York Hospital Association (GNYHA) were scheduled to meet with New York’s Department of Health (DOH) on Feb. 12 to discuss the health plans' continued use of the Sepsis 3 definition for reviewing claims. New York continues to use the Sepsis 2 definition. Dennis Jones, the administrator of patient financial services for Montefiore Nyack Hospital, reports on the backstory.
Guest Talk: Holly Louie, past president of the Healthcare Business and Management Association and the compliance officer for Professional Management, Inc. (PMI), reports on healthcare billing issues that have captured her attention of late.

ICD-11: It’s Coming – So Start Planning Now Feb 05, 2019

Show notes

Although still lingering on the horizon, much like a coming storm, ICD-11 is fast approaching – which is why the new code set is on the radar screen at the American Health Information Management Association (AHIMA). In fact, AHIMA reports that it has begun conducting research aimed at addressing coding in order to determine how productivity, accuracy, and quality can be improved across all settings.

Reporting on ICD-11 and how AHIMA is preparing its members for the next coding milestone during the next edition of Talk Ten Tuesdays will be Julie Dooling, AHIMA’s director of health information management (HIM) practice excellence.

Other segments to be featured on the broadcast include:

The I-10 Coding Report: Are there codes for the extreme cold weather that’s impacting much of the nation? Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, will be reporting on ICD-10 coding for this freezing cold, specifically, associated conditions and external cause codes.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk-Ten-Tuesdays News Desk.
RegWatch: Leading healthcare technology consultant Stanley Nachimson will return with his popular segment, through which he reports on the latest regulatory changes coming out of Washington, D.C.
TalkBack: Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on coding cardiac arrest and will highlight her reporting with a listener poll.

Sepsis-3 versus Sepsis-2: In Search of an Offramp Jan 29, 2019

Show notes

The fallout continues over the recent announcement by UnitedHealthcare (UHC) that it would not use Sepsis-3 when reviewing claims to validate sepsis for payment from providers in the Empire State. New York state law defines sepsis with systemic inflammatory response syndrome (SIRS) criteria, otherwise known as Sepsis-2.

Reporting on Sepsis-3 during the next edition of Talk Ten Tuesdays will be broadcast co-host Erica Remer, MD, founder and president of Erica Remer, MD, Incorporated. Dr. Remer will share insights from a targeted sepsis project that should help clarify how your facility should approach sepsis.

Other segments to be featured on the broadcast include:

Coding Report: The upcoming Super Bowl LIII on Feb. 3 reminds many of the consequences of chronic traumatic encephalopathy (CTE). Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports on CTE.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
The Dunn Report: National health information management (HIM) expert and past American Health Information Management Association (AHIMA) President Rose Dunn returns to the broadcast with a series on the revenue cycle and how HIM can play a role in other areas of the revenue cycle.
Tuesday Focus: The Patient Protection and Affordable Care Act: A federal judge in Texas, U.S. District Judge Reed O'Connor, recently struck down the Affordable Care Act as unconstitutional, ruling that the individual mandate could not be severed from the rest of 44th President Barack Obama's landmark healthcare law. Pending appeal, however, the law remains in place. And what that means for coders will be reported on by Terry Fletcher, a nationally recognized professional provider coding authority.

Code or Not to Code: Revisiting ICD-10-CM Guidelines Jan 22, 2019

Show notes

"The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis." — ICD-10-CM guideline I.A. 19
This guideline is frequently cited as the reason coders list diagnoses because the doctor said so. But is the doctor’s say-so enough? Reporting on this recurring issue during the next edition of Talk-Ten-Tuesdays will be broadcast co-host Erica Remer, MD, founder and president of Erica Remer, MD, Incorporated.
Other segments to be featured on the broadcast include:

Coding Report: It’s the flu season in the United States, with most activity expected to peak between now and February. Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, will be reporting on this developing story.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk-Ten-Tuesdays News Desk.
HIM Report: Julie Dooling, American Health Information Management Association (AHIMA) director of Health Information Management (HIM) Practice Excellence, will report on the Government Accountability Office (GAO) investigation of the different approaches being used and challenges being faced by hospitals seeking to achieve accurate patient matching.
Tuesday Focus: CMS Advanced Practitioner Professional (NPP) Billing: Many providers are still struggling with the NPP billing rules from the Centers for Medicare & Medicaid Services (CMS). Author and educator Deborah Grider, senior healthcare consultant for Karen Zupko and Associates, will report on the need for greater understanding of this complex issue.

Social Determinants of Health: Healthcare Issues Outside Your Hospital Are Affecting What Happens Inside Jan 15, 2019

Show notes

Social determinants of health (SdoH) are swamping hospitals like rising rivers following a storm. A reported $1.7 trillion in healthcare costs are now attributed to 5 percent of the nation’s population, with a majority of that sum related to the SdoH.
And while the focus has been largely on the most vulnerable and disenfranchised members of populations, the new face of SDoH is evolving as a consequence of an increase of natural and manmade disasters, as well as new attention being given to longstanding issues such as rural health, human trafficking, business closures, and loss of pensions for an increasing number of older adults.
Returning to Talk Ten Tuesdays to report on this developing story is nationally recognized SDoH authority, author, and educator Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, the founder of EFS Supervision Strategies, LLC.
Other segments to be featured on the broadcast include:

Coding Report: Coders will be dealing with new payment models in 2019, including one for skilled nursing facilities (SNFs) expected to be released on Oct. 1. Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports this developing story.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
RegWatch: Leading healthcare technology consultant Stanley Nachimson returns with his popular segment, RegWatch, through which he reports on the latest regulatory changes coming out of Washington, D.C.
DocTalk: Talk Ten Tuesdays guest co-host Juliet Ugarte Hopkins, MD, CHCQM, physician advisor of case management, utilization, and clinical documentation at ProHealth Care, reports on the collaboration between coding, clinical documentation integrity, and physician advisors when facing clinical validation denials.

Mystery Disease: Latest Update on AFM Dec 12, 2018

Show notes

The mystery continues.

At the time of this report there were a reported 116 confirmed cases of acute flaccid myelitis (AFM) across 31 states, with the most cases reported in Colorado (15) and Texas (14). Plus, there are another 170 possible cases that haven’t been confirmed.

AFM is similar to polio and leads to a sudden onset of paralysis. This condition mostly affects children younger than 4. These patients experienced a viral illness with fever and cough 3-10 days prior to the paralysis onset.

Returning to Talk Ten Tuesdays to report on this developing story will be Jennifer P. Rubin, MD, attending physician in the neurology division of Northwestern University’s Feinberg School of Medicine.

Other segments to be featured on the broadcast include:

Tuesday Focus: There’s a reported fine line between coding for moderate sedation and monitored general sedation. Exploring this seemingly unchartered territory is Terry Fletcher, a nationally recognized professional physician coding consultant, educator, and auditor.
News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
Dateline Washington: Talk Ten Tuesdays legislative analyst Rhonda Taller has the latest news coming out of Washington, D.C. Rhonda is a member of the HIMSS professional development committee.
TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on an issue that recently caught her attention during her popular TalkBack segment.

Perilous Compliance Challenges Facing Today’s New Coders Dec 04, 2018

Show notes

Never before has the responsibility of an organization to provide clear, facility-specific guidelines and in-depth training for coders been more apparent than it is today – especially now with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) poised to conduct diagnosis-related group (DRG) validation audits. Reporting our lead story during this edition of Talk Ten Tuesdays will be Cari Greenwood who will discuss how your team should intensify training –- particularly when it comes to assigning correct codes for high-frequency, problem-prone, and high-cost diagnoses.

Other segments to be featured on the broadcast include:

News Desk: Mary A. Inman, partner at Constantine Cannon’s London office, reports on the expected dismissal of the $188.1 million False Claims Act lawsuit filed by Med Analytics, LLC against Providence Health, now Providence St. Joseph, for allegedly upcoding various diagnoses.
RegWatch: Leading healthcare technology consultant Stanley Nachimson returns with his popular segment, RegWatch, through which he reports on the latest regulatory changes coming out of Washington, D.C.
Tuesday Focus: The Office of Disease Prevention and Health Promotion (ODPHP), on behalf of the Federal Interagency Steering Committee for Adverse Drug Events, recently released its final version of the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan). Reporting on this developing story will be Ronald Hirsch, MD, vice president of R1 Physician Advisory Services.
CDI Report: ICD10monitor contributor Glenn Krauss continues his reporting on clinical documentation integrity, but this time, he will focus on the recent decision by HHS OIG to conduct DRG validation audits.
TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on an issue that recently caught her attention during her popular TalkBack segment.

To Link, or not to Link: That is the Question for Physician Documentation Nov 27, 2018

Show notes

Are you experiencing this dilemma at your facility? You ask your physicians to add linking verbiage to their documentation for accuracy, which in turn has a negative impact on their publicly reported scores regarding complications and other metrics. Should physicians exclude the linking verbiage? Should they enter “as expected,” or should they simply avoid addressing these issues? Reporting on this complex issue during the next edition of Talk Ten Tuesdays will be Sharon Savinsky, clinical documentation improvement specialist (CDIS) team manager at Winchester Medical Center in Winchester, Va.

Other segments to be featured on the broadcast include:

News Desk: Laurie Johnson will anchor the Talk Ten-Tuesdays News Desk. Johnson is a senior healthcare consultant with Revenue Cycle Solutions, LLC and an ICD10monitor contributor.
Coding Report: Although the Centers for Medicare & Medicaid Services (CMS) has released the final rule on the 2019 Medicare Physician Fee Schedule (MPFS), Dr. Jeffrey Lehrman will report on one issue that CMS did not include in its extensive update.
Tuesday Focus: Alarms are being sounded because of the clinical and privacy issues being raised as a result of offshore coding. Terry Fletcher, a nationally recognized professional physician coding consultant, educator and auditor, will report this developing story.
TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., will report on the recent decision by U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to conduct DRG validation audits.

The Enigma of Sepsis: Providers vs. Payers Nov 13, 2018

Show notes

When it comes to defining sepsis, who wins? Is it providers, who rely on the current definition of sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection?” Or do payers prevail – the ones who control the reimbursement? And under what circumstances would you ever side with a carrier that has denied a claim of sepsis?

Reporting our lead story during this edition of Talk Ten Tuesdays will be Roland Dale, responsible for denials prevention, for Hardin Medical Center, who shares his experience in these situations while offering important and timely advice.

Other segments to be featured on the broadcast include:

News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
Dateline Washington: Talk Ten Tuesdays legislative analyst Rhonda Taller has the latest news coming out of Washington, D.C. Rhonda is a member of the HIMSS professional development committee.
Tuesday Focus: The Centers for Medicaid & Medicare Services (CMS) last week released the final rule on the 2019 Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). Reporting this developing story is Dheeraj Mahajan, MD, president and CEO of Chicago Internal Medicine Practice and Research (CIMPAR, SC), who leads its affiliated group of companies.
TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., will report on the Global Leadership Initiative on Malnutrition (GLIM) during her popular TalkBack segment.

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