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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

This comprehensive guide provides hospital and revenue cycle leadership with vital insights on preparing for CERT audits and establishing processes for compliant documentation. This section delves into the specific criteria and expectations set by CERT audits, emphasizing the need for meticulous attention to detail and documentation accuracy.

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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

The panel featured Jackie Kimmel , Senior Director of Strategy Catalyst for The Health Management Academy , Dr. Adam Fall , Corporate Medical Director of Utilization Management at Erlanger , and Dr. Jeny McNair , President and Chief Physician Advisor at Physician Advisory Services of Med-Metrix. Document why you believe that.

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Avoiding the Pitfalls of Involuntary Nursing Home Discharges/Transfers in Missouri

Healthcare Law Insights blog

In certain cases, nursing homes may discharge or transfer a resident even if the resident does not consent to the discharge or transfer – this is known as an “involuntary discharge” or an “involuntary transfer.” In this case, the resident has the right to appeal the involuntary discharge or transfer. 19 CSR 30-82.050(3).

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New Insights on Medicare Advantage Plans and The Two-Midnight Rule

EvidenceCare

In other words, the MA plan may focus its medical reviews on stays of any length in order to ensure compliance with the Two-Midnight Rule. This also means that the medical record must support the reasonableness of the clinician’s admission decision regardless of the total time spent in the facility.

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Understanding DRG Codes and Their Impact on Hospitals

EvidenceCare

First, the codes are divided into two categories – medical and surgical. Note: CMS documents how each ICD-10 code can be either a CC or MCC here. They would submit their charges post-discharge and be reimbursed. Documentation is crucial for assigning the correct DRG and, consequently, a realistic SOI score.

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All User Bulletin: Admission and Discharge Navigator Optimizations

Connect Care Bytes Blog

Enhancements to Core Admission and Discharge Navigators Connect Care uses "Navigators" to help prescribers complete complex workflows when key tasks are easy to forget. Core "Admission" and "Discharge" navigators organize review (e.g., problem, medication and allergy validation), action (e.g., orders) and documentation (e.g.,

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Upcoming ICD-10 Code Changes for October 1, 2024: What You Need to Know 

Health Prime

These 2025 ICD-10-CM updates are to be used for discharges and patient encounters from October 1, 2024, through September 30, 2025. These changes will impact medical billing, coding practices, and healthcare administration. Our team of experts is dedicated to ensuring that your practice stays ahead of the curve.

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