Health information management (HIM) departments face evolving risks regarding compliance with new coding, billing, and documentation requirements related to the pandemic.
Obtaining clinical documentation that captures the patient’s SOI and ROM should be the objective of every clinical documentation integrity (CDI) program.
The Medicare hospital inpatient prospective payment system (IPPS) final rule for fiscal year (FY) 2021 was published in the September 18 issue of the Federal Register.
There is an inherent conflict between a person’s healthcare needs and a right to privacy. In order to deliver quality care, it would be best if all patient health information…