Mikki Fazzio, RHIT, CCS

Content Integrity Consultant, Principal

Mikki Fazzio, RHIT, CCS, joined Health Catalyst in June 2021 as a principal content integrity consultant. She is responsible for content integrity in the VitalWare® by Health Catalyst VitalKnowledge™ system, the maintenance of VitalWare’s proprietary crosswalk information (including CPT to ICD-10-PCS crosswalks, CPT/HCPCS to modifier crosswalks, and CPT/HCPCS to revenue crosswalks), assisting with responding to specialized client billing and coding questions, and providing educational webinars. Fazzio has 15+ years of experience in the healthcare field. Prior to joining Health Catalyst, she was the Director of Health Information Management and Clinical Documentation Integrity at Thibodaux Regional Health System, where she led a team of hospital and professional coders, CDI specialists, EMR specialists, transcriptionists, scanning technicians, and release of information technicians. Fazzio's main responsibilities included overseeing the Clinical Documentation Integrity program, decreasing and sustaining discharged-not-final-billed dollars for facility and professional coding, and case mix index analysis. She has a degree in Psychology and Health Information Management, as well as certifications as a Registered Health Information Technician and a Certified Coding Specialist through the American Health Information Management Association.

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ICD-10-CM Updates Take Effect in October 2022

The Centers for Medicare & Medicaid Services (CMS) has released updates to its International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) system diagnosis codes for fiscal year (FY) 2023. ICD-10-CM codes, which will increase from 72,750 to 73,639, impact all provider types in both the inpatient and outpatient settings. The updates are effective beginning October 1, 2022. Some of the additions for 2023 include the following:

1. Certain infectious and parasitic diseases.
2. Endocrine, nutritional, and metabolic diseases.
3. Mental, behavioral, and neurodevelopmental disorders.
4. Diseases of the nervous system.
5. Diseases of the digestive system.

Commercial Medical Necessity Edits are Your Key to Fewer Denials

Healthcare organizations risk losing more than $200 billion annually to denied claims. Of this loss, medical necessity denials account for $2.5 billion. In response, providers need a mid-revenue management solution that includes healthcare claims management, such as medical necessity edits (MNEs), and ensures claims fall within acceptable standards. Accounting for MNEs for a broad range of commercial insurances in addition to Medicare and state Medicaid MNEs, the Vitalware® by Health Catalyst medical necessity tool offers a comprehensive, timely, and accurate solution to help organizations avoid lost compensation and revenue delays.

Changes to ICD-10-PCS Codes: CMS Updates Effective October 2022

Changes to the ICD-10-PCS codes for the fiscal year 2023 include 64 deleted codes, 331 new procedure codes, and no revisions. The updates, which take effect on October 1, 2022, bring the total of ICD-10-PCS codes to 78,496. Health system leaders can prepare for the new round of procedure codes by taking inventory of the areas and interventions impacted, including the following:

1. Medical and surgical.
2. Administrative.
3. Extracorporeal or systemic assistance and performance.
4. New technology.

CMS will publish these codes in the 2023 ICD-10-PCS codebook, but they’re available for review now within Vitalware® by Health Catalyst products.

New CPT Codes for 2022: This Year’s Need-to-Know Updates

Healthcare technology continues to evolve, often significantly impacting the delivery of care and therefore reporting and coverage for providers. In response, the American Medical Association (AMA) has developed CPT Category III codes to report emerging technology, services, procedures, and service paradigms. New Category III codes for 2022 take effect on July 1. While these codes don’t guarantee coverage for a particular procedure, providers must assign them as appropriate for accurate data collection. The AMA will publish the new codes in the 2023 CPT codebook, but healthcare leaders can access them now within Vitalware® by Health Catalyst products.

2022 Healthcare Reimbursement Changes Reinstating Significant Inpatient Coverage

The Centers for Medicare and Medicaid Services (CMS) has long published a list of procedures that—for safety reasons—providers could only perform and receive reimbursement for in the hospital inpatient setting (the Inpatient-Only (IPO) list). However, in 2020, CMS announced a plan to phaseout the IPO list, which would have removed the inpatient requirement for certain services. More recently, a CMS ruling reversed the 2020 phaseout, thereby reinstating the IPO list. Many stakeholders consider the reversal of the phaseout a benefit to patients, providers, and hospitals in terms of improved patient safety, increased reimbursement, reduced physician burden, and more.

Surprise Billing in Healthcare: The No Surprises Act Takes a Stand for Patients

Most providers aim to protect patients from unexpected and unmanageable medical bills. But on January 1, 2022, this responsibility becomes law under the No Surprises Act. The upcoming legislation targets surprise medical bills, which occur when a patient unknowingly receives care from out-of-network providers and is subject to higher charges than for in-network care. These unexpected bills degrade the patient experience and decrease the likelihood of payment for care. Surprise bills may also be more common than many consumers and providers realize—according to the Centers for Medicare and Medicaid Services, in 2016, 42.8 percent of emergency room bills resulted in out-of-network charges. With greater price transparency, the No Surprises Act seeks to protect patients but also impacts providers and facilities, ambulance services, and more, who must comply to receive timely payment and avoid penalties.

Healthcare Financial Recovery: A Guide to the COVID-19 Add-On Payment

Healthcare organizations continue to suffer from COVID-19-driven economic setbacks. As a result, getting paid appropriately for services is more important than ever. The federal government provides programs to support healthcare financial recovery, but relief payment isn’t automatic or guaranteed. To qualify for the COVID-19 add-on payment, organizations must stay up to date with the rules and regulations around coding and billing for COVID-19, as compliance with these changes may affect reimbursement.

The following three requirements will help health systems ensure add-on payments for patients diagnosed with COVID-19:

1. Include a copy of the positive COVID-19 laboratory result in the medical record.
2. Create internal polices for COVID-19 results from more than 14 days before admission.
3. Document and appropriately code the COVID-19 diagnosis.

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