Clinical documentation integrity (CDI) is seen through an international lens as the contributions of the American Health Information Management Association’s (AHIMA’s) World Congress are recognized during this edition of Talk Ten Tuesdays. The broadcast will usher in the global celebration, coming just in advance of World Health Day on April 7.

Joining the broadcast will be Alexandre Bouché, who created a new international arm of AHIMA –- the AHIMA World Congress (AWC) –- to help its members achieve their full potential and professional recognition in the Middle East, Southeast Asia, and European markets.

This broadcast will also feature these other segments:

• CDI Report: Dr. Wilbur Lo provides an overview of the methodology of International-Refined (IR-DRGs). Dr. Lo also reports on how providers in the United Arab Emirates (UAE) are experiencing additional annual revenue, improved patient care and quality of data outcomes based on a gap analysis performed by AWC.
  
  
• News Desk: Timothy Powell, a 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, 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, reports on opioids – a topic that continues to generate national attention.

Surprise balance billing is an issue that is not only generating national interest but also legislative engagement on the state level. In Part I of this series, Holly Louie, past president of the Healthcare Business and Management Association, reported on such billing related to insurance company denials. For Part II, Matthew Albright, former Director of the Administrative Simplification Group at the Centers for Medicare & Medicaid Services (CMS), reports on billing laws on the state level, as well as billing protections by the U.S. Senate.

Albright examines trends in surprise balance billing laws being seen passed in the states, specifically with regard to reimbursement benchmarks. And touches on what states are considering balance bill laws in their 2019 legislative sessions and what the status is on the U.S. Senate’s bipartisan efforts in this area.

The broadcast will also feature these other segments:

• The ICD-10 Coding Report: Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, will be reporting on latest coding news. 
  
  
• CDI Report: Mel Tully, vice president of clinical services and education for the healthcare division of Nuance Communication, will report on compliance issues associated with clinical documentation integrity.  
  
  
• News Desk: Timothy Powell, a compliance expert, and ICD10monitor national correspondent will anchor 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 how HIM can play a role in other areas of the revenue cycle.
  
  
• TalkBack: Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, once again reports on SIRS, Sepsis, and Rule No. 1.

Imagine an almost seamless transition from ICD-10 to ICD-11, unlike the sturm and drang that characterized the transition from ICD-9 to ICD-10 – which, finally, after the dust settled, became effective in 2015. 

Eliminating the speed bumps could happen. The National Committee for Vital Health Statistics (NCVHS) recently sent a letter to the Secretary of the U.S. Department of Health and Human Services (HHS), proposing that the massive agency use sub-regulatory processes to make version updates to the International Classification for Diseases (ICD) in the same way it handles updates to all the other named HIPAA code set standards. Moreover, HCVHS said that HHS should invest now in a project to evaluate ICD-11 and develop a plan that will enable a smooth and transparent transition at the optimal time.    

Reporting our lead story during this edition of Talk Ten Tuesdays will be Margaret Skurka, past president of the International Federation of Health Information Management Associations, IFHIMA, and the current IFHIMA/AHIMA representative to the World Health Organization (WHO) Family of International Classifications Education and Implementation Committee. That committee does work on ICD-11, as well as work on improving the quality of coded data internationally while recognizing coders around the world.

The broadcast will also feature these other segments:

• Coding Report: World Kidney Day was celebrated on March 13, 2019. Laurie Johnson provides some information about chronic kidney disease and its complications along with the coding of this chronic condition. Johnson is a nationally recognized coding authority and senior healthcare consultant at Revenue Cycle Solutions, LLC.
  
  
• News Desk: As expected, the American Medical Association’s (AMA’s) CPT® editorial board last month approved major changes to documentation and code selection guidelines for evaluation and management (E&M) codes. The changes were announced last week and are expected to become effective in 2021. Reporting this developing story from the Talk Ten Tuesdays News Desk will be Dr. Jeffrey Lehrman, a practicing podiatrist, and consultant to the Health Policy and Practice Department of the American Podiatric Medical Association.
  
  
• Tuesday Focus: Virtual check-ins are the new Centers for Medicare & Medicaid Services (CMS) communications technology-based payable service. Reporting this important story is nationally recognized professional physician coder and auditor Terry Fletcher. 
  
  
• TalkBack: Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on the events that took place during this week’s national conference of the American College of Physician Advisors.

We are honored to welcome the President and Chair of the 2019 American Health Information Management Association (AHIMA) Board of Directors, Valerie Watzlaf, Ph.D. to this edition of Talk Ten Tuesdays. 

Dr. Watzlaf is vice chair of education and associate professor within the Department of Health Information Management (HIM) in the School of Health and Rehabilitation Sciences (SHRS) at the University of Pittsburgh. She also holds a secondary appointment in the Graduate School of Public Health. In those capacities, she teaches and performs research in the areas of HIM, epidemiology, quality improvement, statistics, and long-term care. Welcome, Dr. Watzlaf.

This broadcast will also feature these other segments:

• The ICD-10 Coding Report: Chronic conditions have been in the news lately and Laurie Johnson reports on the ten most expensive conditions with regards to ICD-10 codes as well as clinical documentation and HCC impacts. Johnson is a nationally recognized coding authority and senior healthcare consultant at Revenue Cycle Solutions, LLC.
  
  
• News Desk: Timothy Powell, a 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, through which he reports on the latest regulatory changes coming out of Washington, D.C.
  
  
• GuestTalk: Holly Louie, past president of the Healthcare Business and Management Association and the compliance officer for Professional Management, Inc. (PMI), will report on healthcare billing issues that have captured her attention of late.
  
  Click here to view the link mentioned by Stanley Nachimson in his segment RegWatch

As the clinical documentation integrity (CDI) industry continues to grow beyond the traditional inpatient setting, the American Health Information Management Association (AHIMA) is working to provide best-practice resources to provider stakeholders from across the continuum of care. Sharing an update on AHIMA’s advocacy during this edition of Talk Ten Tuesdays will be Tammy Combs, the Association’s director of HIM practice excellence.

The live broadcast will also feature these other segments:

• The ICD-10 Coding Report: Nationally recognized coding authority Laurie Johnson, senior healthcare consultant at Revenue Cycle Solutions, LLC, reports on the proceedings taking place during the first day of the Centers for Medicare & Medicaid Services (CMS) Coordination and Maintenance Committee meeting, which was scheduled to get underway Tuesday morning at CMS headquarters in Baltimore.
  
  
• News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.
  
  
• SDoH Update: Returning to the Talk Ten Tuesdays broadcast to report on the developing story of social determinants of health (SDoH) will be nationally recognized SDoH authority, author, and educator Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, the founder of EFS Supervision Strategies, LLC.
  
  
• TalkBack: Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on a current healthcare issue that has caught her attention during her popular TalkBack segment.

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.

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.

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. 

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.

"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.