Pinnacle's Blog & Publications
New ACO/VBC Changes Announced: What You Need to Know!
Posted On: February 16, 2023Continue Reading >Our healthcare industry is undergoing a major transformation, with a focus on shifting from a fee-for-service model to a value-based model that prioritizes quality and outcomes over volume and cost. CMS Administrator Chiquita Brooks-LaSure, stated “Through the CMS accountable care initiatives and working with our partners, we have made significant progress in addressing our greatest healthcare challenges.” Administration is looking to further the engagement and participation in various payment models by planning to release three to four new payment models, including more key stakeholders in healthcare. These models will be centered around advancing primary care, engaging specialists in ...
Sepsis Coding: How to Properly Code Sepsis
Posted On: January 26, 2023Continue Reading >Introduction:
Sepsis is a potentially life-threatening complication of an infection and occurs when chemicals released in the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that damage multiple organ systems, causing them to fail. While the coding for sepsis can be particularly challenging, fortunately, we have the ICD-10-CM Official Guidelines for Coding and Reporting to use as a guide.
Chapter 1 of the ICD-10-CM guidelines provides incredibly detailed instruction on coding for sepsis, severe sepsis, and septic shock infections. The guidelines instruct to first assign the appropriate code for the underlying ...
Clinical Documentation Improvement: Are EMR Shortcuts Wreaking Havoc on Your Practice’s Documentation?
Posted On: January 16, 2023Continue Reading >As providers look for ways to document more efficiently, they are increasingly turning to technology-based shortcuts. Unfortunately, there are some pitfalls associated with relying on some electronic medical record (EMR) conveniences. In this article, we will discuss a few EMR shortcuts that have the potential to wreak havoc on your documentation.
Drop down ICD-10-CM Codes
Many EMRs offer the option to select diagnoses with correlating ICD-10-CM codes from a drop-down menu in the assessment and plan portion of the note which can be problematic for multiple reasons. We have encountered audits where providers consistently coded ...
PHC 3rd Quarter 2022 Real Estate Newsletter
Posted On: November 18, 2022Continue Reading >The Pinnacle Real Estate Group consists of a combination of professionals who use their extensive experience in both valuation and transaction services within the healthcare real estate industry to guide clients through multiple types of arrangements in a time-efficient and cost-effective manner.
This Newsletter covers recent activity and conditions specifically impacting the national healthcare real estate market and those who are learning how to succeed in it. The Pinnacle Real Estate Group has compiled the following current market information from sources such as CoStar, CBRE, and HREI.
Healthcare Real Estate Transactions
$10.75 Million MOB acquired ...
Diagnosis Coding: When to Assign a Diagnosis for E/M Services
Posted On: November 11, 2022Continue Reading >With the implementation of the AMA (American Medical Association) E/M (Evaluation and Management) documentation guidelines for office and outpatient visits in 2021 (and the pending 2023 E/M guideline changes for emergency department, inpatient, outpatient, nursing facility, and home/residence visits), there has been confusion about when to assign / capture a diagnosis code for E/M services.
Per the ICD-10-CM Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services Guideline J, we should code all documented conditions that coexist:
Code all documented conditions that coexist at the time of the encounter/visit and that require or ...
Summary Of CMS Proposed Rule Changes For 2023
Posted On: October 21, 2022Continue Reading >(Based on the July 7, 2022 Proposed Rule)
Rate and Conversion FactorsWith the budget neutrality adjustments and the required statutory update to the conversion factor for CY 2023 of 0% and the expiration of the 3% increase in PFS payments for CY 2022, the proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 (4.4%) to the CY 2022 PFS conversion factor of $34.61.
Updated Medicare Economic Index (MEI) for CY 2023CMS is proposing to rebase and revise the MEI cost share weights for CY 2023 as well ...
Smart Pricing of Lumbar Stand-Alone Devices
Posted On: September 21, 2022Continue Reading >Today’s vendor technology is no longer siloed into a specific classification. For example, an ALIF (anterior lumbar interbody fusion) device used to be just an ALIF. Today, that same ALIF can be used as a spacer, lumbar stand-alone assembly, or an ALIF with buttress assembly.
Assigning pricing to the assembled device is a challenge as vendor’s will typically request a much higher price than average for ALIFs that can be used as assemblies.
Where do you start?
Review your current pricing.
- If you don’t have construct/component pricing, calculate your average cost for an ALIF ...
Smart Pricing of Cervical Stand-Alone Devices
Posted On: September 21, 2022Today’s vendors now offer specific implant technology that can no longer be categorized into a single specific implant classification. For example, a cervical spacer used to be just a cervical spacer. Today, that cervical spacer may be cleared for use by the FDA and classified as either a:
- Cervical Spacer or Cage (requiring supplemental fixation)
- Cervical Stand-Alone Device – Cage
The two constructs above should have the same price; however, the cervical stand-alone assembly (Cage + Plate + Screws) pricing will be higher. Ergo, negotiating contracts and pricing for complex implants such as these can be challenging.
CMS Releases PY 2021 Financial and Quality MSSP Numbers
Posted On: September 8, 2022CMS Releases PY 2021 Financial and Quality MSSP NumbersContinue Reading >Using Implant Data to Facilitate Surgeon Engagement
Posted On: August 30, 2022Continue Reading >Engaging surgeons to assist in contracting for their implants has long been a challenge for most hospitals. Historical feedback from surgeons ranges from “it’s not my problem” to “I’ll just take may cases across the street if I cannot use my vendor of choice.” Presently, organizations may now offer surgeons co-management, value-based, and gainsharing arrangements, as well as other forms of contractual alignments with hospitals. These new business models have proven useful in bringing better balance to the surgeon-hospital relationships vs the traditional surgeon-vendor relationship.
So, how do you engage your surgeons?
Prior to meeting with ...
