Observation Committee – Member Articles
Federal Officials Seeking to Mitigate Maternity Deserts
January 22, 2024 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
If you came across my recent report on the significant concern of “maternity deserts” in the U.S., as you will recall, the widely accepted definition...
News Highlights for SDoH to Start off 2024!
January 8, 2024 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
Happy 2024! This article will focus on a couple of news highlights that emerged over the holiday break. First, the LOINC and Health Data Standards...
Maternity Deserts: The Growing Concern of America’s Maternal Care
December 4, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
It has been about six months since I last reported on the growing concern of maternal care, and in particular, the known issues of maternal...
Understanding the U.S. Playbook to Address the Social Determinants of Health
November 27, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The Biden Administration has released a new playbook addressing three “pillars” of emphasis related to the social determinants of health (SDoH), from the Domestic Policy...
The Health Benefits of Gratitude
November 20, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
In honor and celebration of Thanksgiving, a time to be thankful for all we have, I thought it would be appropriate to discuss the growing...
Why Understanding the ABN is Essential for Providers and Medicare Beneficiaries
November 17, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The Advance Beneficiary Notice (ABN), Form CMS-R-131, provided by the Centers for Medicare & Medicaid Services (CMS, is vital for healthcare providers, revenue cycle teams...
SDoH Z Codes: How it Took a Village to Cleared the Confusion
November 6, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The Gravity Project and the American Medical Association (AMA) have taken a significant step towards clarifying the coding process for the social determinants of health...
Concerns that AI May Be Perpetuating Discrimination
October 30, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
Yes, I understand how artificial intelligence (AI) in healthcare, and maybe in life, can be an appealing time-saver. Speakers at conferences across the country are...
Ethical Considerations When Sending a Patient to a Low-Rated Post-Acute
October 23, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
At the American Case Management Association (ACMA) Leadership and Physician Advisor Conference, a question was posed to the speakers from an audience member: “My healthcare...
The Inpatient-Only List & The Role Utilization Review Can Play
October 16, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
EDITOR’S NOTE: While there have been attempts to phase out the IPO List, the reality is that it continues to be a significant factor in healthcare...
Is a Lack of Cultural Competency Closing the Doors on Access to Care for Those Most in Need?
October 2, 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
As it pertains to my students undergoing clinical training, one of the social workers who is currently working in an elementary school in a predominantly...
Who Owns Initial Patient Assessment: Gaining Better Understanding of Case Management Documentation
September 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
Let's focus on the ideal state of what case management documentation should look like.
CMS Releases New Source for Collecting Z Codes
September 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
To help improve the collection of the social determinants of health (SDoH) Z codes, the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health released a new Z code infographic.
How Can Case Management Provide Support for Coding?
August 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
Discussion about the benefits of coding and case management (CM) collaboration – in particular, the value of CM documentation.
It’s Official: CMS Recognizes Homelessness as a CC
August 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The final ruling for Z59.00, unspecified homelessness, with subcategories of 59.01, and 59.02- sheltered and unsheltered homelessness, will now be considered a complication or comorbidity (CC), based on the higher average cost to care for such individuals.
Why it’s Time to Retire the Term Non-compliant
August 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
Non-compliance in healthcare typically means a patient who intentionally refuses to take prescribed medication or does not follow treatment recommendations. This term is often used in medical documentation as physicians and/or care team professionals categorizing patients in the ‘not doing what I say’ category. The effects of this term project’s a picture of intentional negligence by the patient, placing blame on their choices.
Are Hospitals Over-consulting Physical Therapy?
June 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
A regular comment from hospitalist medicine and case management staff is “we are waiting on the PT consult” or “we are waiting for PT to document their recommendations.”
Strategies for Creating a Valuable Utilization Review Committee
May 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The federal statute 42 CFR § 482.30, in the Conditions of Participation for Utilization Review (CoP), requires that each hospital must have in effect a utilization review (UR) plan and a utilization review committee (URC). The CoP lists specifications regarding committee requirements; however, it is left up to the hospitals to decide how functional these committees will be.
Knowing When and How to Fight the Good Fight
March 2023 | Tiffany Ferguson, LMSW, CMAC, ACM | ICD10Monitor.com
The need for benchmarking denials is evident as there are variations in hospital appeal processes.
Making Meaning out of Avoidable Days: Part II
December 2022 | Tiffany Ferguson, LMSW, CMAC, ACM | RACMonitor.com
What are some common avoidable day reasons? There are three main categories: delays related to transitions to the next facility, whether that be a skilled or psychiatric placement; delays related to family decision making and social factors; and delays related to internal processes such as not having MRI services on weekends or limitations with consulting specialists.
Making Meaning out of Avoidable Days: Part I
December 2022 | Tiffany Ferguson, LMSW, CMAC, ACM | RACMonitor.com
Let’s talk about avoidable days and discharge delays that occur with our patients, and how they can meaningfully impact patient care and social determinants of health (SDoH).
Why Has the Hospital Turned into Long-Term Care?
October 2022 | Tiffany Ferguson, LMSW, CMAC, ACM | RACMonitor.com
Theoretically, we know that patients needing custodial care are not supposed to be in the hospital without medical necessity, but in many cases, they show up in the emergency room and are admitted into the hospital because there is nowhere else for them to go.
How to Integrate a SDoH Coding and Quality Question
October 2022 | Tiffany Ferguson, LMSW, CMAC, ACM | RACMonitor.com
Quality reporting will be mandatory in 2024, and then under a payment determination in 2026.
Key Considerations in Developing an Observation Unit
June 2022 | Bartho Caponi, MD, FACP, FHM
The recent ACPA Observation Committee Town Hall on Observation Units answered many questions about how to set up such a unit, how billing works in an observation unit, and discussed many different models for a unit. I wanted to follow up on what I consider to be a few key points that were not addressed in detail.
Building an Internal Electronic Process for Medicare Short-Stay Admission Reviews
October 2021 | Anuja Mohla, DO
Observation committee co-chair Dr. Anuja Mohla discusses how to use a proactive approach toward conducting internal short- stay admission reviews to help identify and correct any errors prior to claims submission in "Building an internal electric process for Medicare short- stay admission reviews" by Dr. Anuja Mohla and Patty Resnik, originally printed by the Health Care Compliance Association's Compliance Today....
Observation Unit Pandemic Operation 2020, A National Survey by the ACPA
January 2021 | Anthony Joseph, MD; Amit Wadhwa, MD, FAAEM; Anuja Mohla, DO; Bartho Caponi, MD, FACP, FHM; Robert Tano, MD; Russell Firman, MD, FACEP, CHCQM, FABQAURP–PHYSADV; Steven Meyerson, MD; Bernard H. Ravitz, MD
Observation Services have become increasingly important for patients who benefit from hospitalization for a short period of time beyond the Emergency Department. Two major approaches to the care of these patients has emerged...
What is Your Real Observation Rate? What Should It Be?
March 2020 | Steven Meyerson, MD
Hospital CFOs are often concerned about their hospital’s observation rate. This is a reasonable consideration because there is generally a significant revenue difference between inpatient and outpatient observation reimbursement...
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