The Wilshire Group Blog

Epic XGM 2015 Contractual Adjustments (This presentation lives on Epic's UserWeb. UserWeb logins are required to view the content.)

A large healthcare organization in the Pacific Northwest faced challenges after an internal Sarbanes-Oxley (SOX) audit found process, segregation of duties, and control issues. The Wilshire Group came in to assess the problems, develop a comprehensive [...]

We are half-way there!  The House overwhelmingly passed legislation to repeal Medicare's sustainable growth rate (SGR) payment formula – without any mention of ICD-10. So the bill does nothing to change the current implementation date of 10/1/15. The vote [...]

Even in the dozen years or so that I’ve been working, electronic communication has changed so much. We are all on the go, and it’s common that a lot of email is done from phones & tablets; maybe even more so than laptops. With this comes a tendency to [...]

I was reading an article today about healthcare reform and the affordable care act, which linked an increase in CDI staff with the increased use of electronic health records. I began to reflect on the past 10+ years in the Clinical Documentation [...]

Electronic health records continue to be instituted within hospitals in order to more efficiently capture the documentation of the patient story. In a recent article “Clinical Documentation in the 21st Century” we hear the position of the ACP (American [...]

As of January 1, 2015, the AMA is overhauling a select group of presumptive testing laboratory CPT codes. This shift moves us from a structure based on an identifying code for type of test performed to one that groups like tests based on number performed [...]

As of January 1, 2015, CMS made changes to how the modifier -59 should be used. Current guidelines result in -59 being used incorrectly on a frequent basis and as a result of this misuse, there is a high risk of overpayment and audit from OIG, RAC, or [...]

CMS (Center for Medicare & Medicaid Services) has been working to decrease a number of conditions they feel should not happen while patients are in the hospital = HAC (Hospital Acquired Condition). The ACA (Affordable Care Act) created the HAC Reduction [...]