After months of discussions with the Cabinet for Health and Family Services (CHFS) via the KHA Medicaid Technical Advisory Committee (TAC) meetings, monthly Medicaid managed care organization (MCO) issue list meetings, individual meetings with CHFS and presentations to the Medicaid Advisory Committee (MAC), the Cabinet has made a final decision regarding sepsis.

On Wednesday, Department for Medicaid Services (DMS) Medical Director Judy Ann Theriot released a memo detailing coding and reimbursement guidelines for sepsis. CHFS will follow the CMS DRG and ICD-10 definitions of sepsis. MCOs are directed to "...base utilization management for sepsis on sepsis-2 criteria until such time that CMS adopts sepsis-3 criteria."

View the memo for more details.

KHA Solutions Group Affinity Partner ChartWise’s three-time best in KLAS award-winning CDI software provides the most advanced and proven Clinical Documentation Improvement (CDI) and Denials Management (DM) solution available to meet the myriad of revenue cycle challenges faced by providers.

Developed by medical and coding professionals, ChartWise combines Natural Language Processing (NLP), Machine Learning (ML) and Artificial Intelligence (AI) technology with sophisticated clinically designed workflows that guide physicians, documentation and denials management personnel to identify and validate all clinical complications and indicators that have not been specified completely or accurately in the clinical record.

ChartWise is used by over 125 hospitals today with an average ROI of 13X...

KHA Solutions Group Affinity Partner FairCode bridges the gap between your attending physicians and hospital coders. The result? Patient acuity and Case Mix Index is more accurately captured; your reimbursement adjusts accordingly. Physician-conducted medical chart reviews happen in real time, significantly impacting quality and bottom line results. From clinical chart reviews to payor denial defense, FairCode's physicians are a part of your team! Add them to your existing CDI initiatives, and see the difference.

FairCode Associates, LLC was founded in 2001 by a team of physicians and nurses to improve coding documentation and compliance in hospitals. We are dedicated to the correct documentation of patient acuity, and to ensuring that our clients receive full and fair compensation for the care they render.

To learn more about how FairCode can help...

KHA Solutions Group Affinity Partner FairCode Associates was founded in 2001 by a team of physicians and nurses to improve coding documentation and compliance in hospitals. They are dedicated to the correct documentation of patient acuity, and to ensuring that their clients receive full and fair compensation for the care they render.

FairCode's specially trained physicians and coding professionals have been working with clients nationwide. This list includes academic medical centers, teaching hospitals, rural community hospitals and multi-hospital health systems.

They work closely with your coders and CDI team members to bridge the gap between clinical documentation and the assignment of codes. Using advanced technology to support peer-to-peer communication with attending physicians, a DRG-specific database of historic changes, (to say nothing...

At a meeting on September 14, 2011, the ICD-9-CM Coordination and Maintenance (C&M) Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10, which would end one year after the implementation of ICD-10. The implementation of ICD-10 was delayed from October 1, 2014, to October 1, 2015, by final rule CMS-0043-F issued on July 31, 2014. 

A notice from CMS is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1240.pdf. The notice details who will be affected and what you need to know along with links to additional information to prepare.

The Kentucky Hospital Research and Education Foundation (KHREF) presents the 2014 ICD-10 Webinar Training Series. This webinar training series will offer three webinars designed to get coders prepared for the mandatory ICD-10 conversion on October 1.

Overall Objectives of the Webinar Series:

Understand how ICD-9-CM compares to ICD-10-CM Understand the structure and format of ICD-10-CM Review and Coding of Diagnosis Codes in Chapter 1 – 21 of the coding book  Online registration for the following sessions is available at: http://secure.kyha.com/meetingregistration.asp:

Part 1 Thursday, April 10 2:00 p.m. - 4:00p.m. (ET)   Part 2 Thursday, April 24 2:00 p.m. - 4:00p.m. (ET)   Part 3 Thursday, May 1 2:00 p.m. - 4:00p.m. (ET) Please view the brochure...

The Kentucky Hospital Research and Education Foundation (KHREF) will host two webinars in February for KHA members.

Inpatient versus Outpatient and Part B Inpatient Billing will be held February 11 from 9:30 a.m. to 11:00 a.m. (ET). This program will help participants sort out the confusion surrounding when a patient is an inpatient vs. being an outpatient specific to billing and coding.

Physician Compensation in a Value-Based World will be held February 27 from 1:00 p.m. to 2:00 p.m. (ET). As health care reimbursement transitions from volume to value based, it becomes essential for physician compensation plans to evolve in order to ensure success under changing financial incentives. The objectives of this program are to: