Talk Ten Tuesdays

In continuing our observance of American Heart Month, during the next live edition of the Talk Ten Tuesdays live Internet radio broadcast we will zero in on the topic of coding and clinical documentation integrity (CDI) issues related to cardiovascular procedures – and, specifically, the importance of obtaining pre-authorizations for cardiology procedures.

Obtaining cardiology procedure pre-authorizations tends to be a time-consuming process, depending on the complexity of the patient’s insurance coverage and staff experience. And that is why we invited Susie Vestevech, the COO for TiaTech USA, to walk you through the process, which can range from several days to several weeks, often requiring multiple phone calls and documentation submissions.

Every year, some 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds. Making certain that your facility is prepared to obtain cardio procedure pre-authorizations is of vital importance every month, not just in February.

The live broadcast will also feature these other segments:

• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
  
  
• SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of coding and the SDoH.
  
  
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
  
  
• TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

February is American Heart Month, a time to raise awareness of cardiovascular health and to shine the light on cardiac issues, especially myocardial infarction.

Unfortunately, every year about 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds. 

And that is why we invited the Chief Executive Officer for the Innova Revenue Group, Lidiya Ter-Markorova, a clinical documentation integrity expert, to discuss documentation and coding pain points for myocardial infarction during the next live edition of Talk Ten Tuesdays.

The live broadcast will also feature these other segments:

• Coding Report: Patricia Chua will report on the latest coding news.
• SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of coding and the SDoH.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment. 

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As rural hospital closures continue to increase (136 have occurred between 2010 and 2021), health information management (HIM) and clinical documentation improvement (CDI) professionals have key roles in ensuring revenue integrity and optimization essential to sound operations and access. 

Even so, small facilities, especially those operating independently, simply do not have the resources that larger chains have to negotiate favorable payer contracts and to implement processes, technologies, and training essential to withstanding payer denials.

In addressing these crucially important issues, Talk Ten Tuesdays, the live Internet radio program produced by ICD10monitor, will begin a new series that will address rigorous revenue integrity solutions that can be developed in a rural environment, while offering tips in creating win-win scenarios with medical/provider staffs. 

Join expert coder James S. Kennedy, MD – a native of East Tennessee, which has its own share of rural hospitals – as he offers experience, guidance, and hope essential to success.

The live broadcast will also feature these other segments:

• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
• SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of coding and the SDoH.
• Talk Law: Healthcare attorney Karen N. George with the Los Angeles-based law firm of Buchalter will resume her popular segment, reporting on healthcare law.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.  

Who knew that when the venerable American Medical Association’s (AMA’s) combining two hospital encounter service types into one code set of inpatient/observation services – initial and subsequent – consternation would be the outcome. The confusion: what entity can actually bill an inpatient initial code, 99221-99223, and who must default to subsequent codes or report office and other outpatient codes when seeing patients in the observation setting?

The good news: during the next live edition of the long-running and popular Talk Ten Tuesdays Internet broadcast, Terry Fletcher will return to the broadcast and offer her interpretation of the rules, and how multi-specialty practices will handle these changes. Moreover, Fletcher, a nationally recognized professional coder, educator, and auditor, will report on the contrast between CPT® and Medicare when reporting these services.

The live broadcast will also feature these other segments:

• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
• SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of coding and the SDoH.
• Journaling John: John Zelem, MD, FACS, founder and CEO of Streamline Solutions Consulting, will continue with his journal entries.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

The term “DRG mismatches” is most often used to describe situations wherein the working diagnosis-related group (DRG) selected by the clinical documentation improvement specialist (CDIS) differs from the final coded DRG, signaling that the CDIS and the coder have arrived at different principal diagnoses. In other situations, a procedure may have been coded incorrectly by the CDI professional, causing the DRG mismatch.

But here’s good news: there’s a new workflow for resolving inpatient DRG mismatches. With this new workflow, the CDIS and coder no longer have to spend countless hours reconciling DRG mismatches.

During the next live edition of Talk Ten Tuesdays, Patty Chua, president of Innova Revenue Group, will report on the positive coding implications this new workflow has created.

The live broadcast will also feature these other segments:

• Revenue Cycle Report: Susan A. Vestevich, JD, chief operations officer for Tia Tech USA, will report on the need for physician credentialing to ensure proper billing and reimbursement.
• SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will make her debut appearance on Talk Ten Tuesdays, having been a regular panelist on the long-running Monitor Mondays. Ferguson will report on the news that’s happening at the intersection of coding and the SDoH.
• Journaling John, MD: John Zelem, MD, FACS, founder and CEO of Streamline Solutions Consulting, will continue with his journal entries.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• Point of View: James S. Kennedy, MD, president of CDIMD, will serve as co-host, and will report on a subject that has caught his attention.

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Within the hospital setting, the term “mismatch” is most often used to describe a situation wherein the final working diagnosis-related group (DRG) selected by the clinical documentation improvement (CDISs) specialists from the final coded DRG.

This can be due to many reasons. One of the most frequent reasons is that the CDI professional and coder have arrived at a different principal diagnosis. In other situations, a CC (complication or comorbidity) or MCC (Major CC) may not have been coded by either the CDI professional or the coder. In still other situations, a procedure may have been coded incorrectly by the CDI professional, causing the DRG mismatch.

There are also other reasons for mismatches, as you’ll discover during upcoming editions of the long-running and popular live Internet broadcast Talk Ten Tuesdays. ICD10monitor and Talk Ten Tuesdays are joining forces with Innova Revenue Group to produce a two-part series, debuting next week: “DRG Mismatches.” Reporting our lead story will be Lidiya Ter-Markarova, a principal at Innova Revenue Group.

The live broadcast will also feature these other segments:

• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
• RegWatch: Stanley Nachimson, founder of Nachimson Advisors, LLC, will report on the latest regulatory news coming out of Washington, D.C.
• Journaling John: John Zelem, MD, FACS, founder and CEO of Streamline Solutions Consulting, will continue with his journal entries.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

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Telehealth is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state. When the public health emergency (PHE) was declared in March of 2020, most states, followed the federal exceptions under the 1135 CARES Act waivers, allowing, an out-of-state provider to render services via telemedicine in a state where they are not located, or allow a clinician to provide services via telehealth in a state if certain conditions are met. However, as of summer 2021, 80 percent of the states implemented telehealth pandemic workarounds. Because these laws were issued under state emergency declarations, they were never meant to be permanent. During the next live edition of Ten Tuesday, healthcare consultant, Terry Fletcher will report on some updates to state  rules and what physicians need to do to make sure they are compliant. 

The live broadcast will also feature these other segments:

• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
• RegWatch: Stanley Nachimson, founder of Nachimson Advisors, LLC, will report on the latest news regarding ICD-11. 
• Journaling John: John Zelem, MD, FACS, founder and CEO of Streamline Solutions Consulting, will continue with his journal entries.
• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.