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Transient Tachypnea of the Newborn (TTN) TTN : a parenchymal lung disorder characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid. It is the most common cause of respiratory distress in late preterm and term infants and is generally a benign, self-limited condition. Clinical Manifestations of TTN · Onset usually between the time of birth and two hours after delivery · Tachypnea – most common feature with respiratory rate > 60 breaths per minute · Infants with more severe disease may exhibit: Cyanosis Increased work of breathing which includes: Nasal flaring Mild intercostal and subcostal retractions Expiratory grunting · Anterior-posterior diameter of the chest may be increased · Typically with clear lungs (no rales/rhonchi) · Mild to moderate TTN are symptomatic for 12-24 hours but signs may persist as long as 72 hours in more severe cases · Characteristic radiographic features: o CXR – increased lung volumes with flat diaphragms, mild cardiomegaly, prominent vascular markings in a sunburst pattern originating at the hilum, fluid in the interlobar fissures, pleural effusions, alveolar edema appearing as fluffy densities. There are no areas of alveolar densities or consolidation o Lung US – pulmonary edema, compact B lines, double lung point, regular pleural line without consolidation TTN is a benign disorder and pathologic conditions that also present with respiratory distress must be excluded. Pneumonia – chest radiography differentiates PNA from TTN as neonatal PNA is characterized by alveolar densities with air bronchograms or patchy infiltrates, not seen in TTN. Sepsis – infants with sepsis and respiratory distress are differentiated from those with TTN with the persistence of additional symptoms and the lack of the characteristic chest radiographic findings of TTN. Congenital cardiac disease - TTN is distinguished from congenital heart disease by physical findings (e.g., heart murmur, abnormal precordial activity), chest radiography, pre- and post-ductal pulse oximetry, and echocardiography. Respiratory distress syndrome – differentiated from TTN with a characteristic chest radiograph of a ground glass appearance with air bronchograms. Caused by surfactant deficiency most common in very preterm infants. Code for Transient tachypnea of newborn (TTN) falls under ICD-10 Chapter 16 – Certain conditions originating in the perinatal period [P00-P96] · P19-P29 – Respiratory and cardiovascular disorders specific to the perinatal period · P22 - Respiratory distress of newborn · P22.0 – Respiratory distress syndrome of newborn · P22.1 – Transient tachypnea of newborn · P22.8 – Other respiratory distress of newborn · P22.9 – Respiratory distress of newborn, unspecified Additional Tips: · TTN is also documented as Respiratory distress syndrome Type II, Wet lung syndrome · Tachypnea alone is just a symptom · Most common risk factors for TTN include prematurity, Cesarean delivery, maternal diabetes, maternal obesity, maternal asthma · Infants with TTN rarely require a fraction of inspired oxygen (FiO2) >0.4. References Johnson, K. E. (2021, August 30). Transient tachypnea of the newborn. UpToDate. www.uptodate.com/contents/transient-tachypnea-of-the-newborn “Respiratory Conditions Neonatal.” Pro ACDIS Pocket Resource Online, pro.acdis.org/inpatient/conditions/respiratory-conditions-neonatal. Accessed 4 Dec. 2023.

Can Providers Truly Win?

Cincinnati, OH — UASI is excited to announce the addition of Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRC, to the team as Managing Consultant in Clinical Documentation Integrity (CDI). Rachel brings over 15 years of experience in CDI and healthcare management, with a well-rounded background as a CDI Specialist, Educator, and Auditor. Her expertise in inpatient hospital CDI/coding, CDI technology, risk adjustment methodologies, and Medicare will significantly enhance UASI's commitment to delivering exceptional documentation solutions. Rachel has demonstrated her dedication to advancing CDI through her strong leadership in program and project management, with a Master's degree in Nursing Administration from Jacksonville University. She has worked closely with physicians to implement effective CDI strategies and has a proven track record in PSI prevention and Medicare compliance. “I am passionate about all things CDI and am thrilled to bring my experience to UASI,” said Rachel Mack. “I look forward to working with a team that shares my commitment to enhancing healthcare outcomes through innovative CDI practices.” Rachel's industry influence extends beyond her work with hospitals. She has been a sought-after speaker at major industry conferences, including her recent presentation on Social Determinants of Health (SDoH) at the 2023 ACDIS Conference alongside Connie Ryan. She also organized and presented at Vizient’s webinar series in 2021, 2022, and 2023, covering topics like CDI and Cardiac Surgery, Sepsis, Respiratory Failure, Risk Adjustment, and PSIs/HACs. Rachel's expertise and thought leadership were also featured at several ACDIS Conferences. About UASI For over four decades, UASI Solutions has led the healthcare industry in revenue cycle management, providing tailored solutions to optimize fiscal performance and drive sustainable growth. Established in 1984, our commitment to innovation and client success has solidified our position as trusted partners nationwide. With a comprehensive suite of services, including Remote Coding, Clinical Documentation Improvement, and Revenue Integrity, we remain dedicated to delivering value and driving results for our clients every step of the way. For more information, please visit www.uasisolutions.com .

Cincinnati, OH — UASI is proud to welcome Lou Ann Wiedemann, MS, FAHIMA, RHIA, CDIP, CHDA, as Managing Consultant in Coding and Auditing. Lou Ann brings over 22 years of leadership experience in health information management, association management, and strategic planning. Her expertise in business and content development, coupled with her passion for data-driven decisions, mentoring young professionals, and fostering collaboration, will strengthen UASI’s position as a leader in revenue cycle management. Lou Ann’s dedication to the health information profession is evident through her impressive credentials, including a Master's of Science in Health Information Management, and recognition as a Fellow of AHIMA. In addition to her coding and CDI expertise, she brings a wealth of experience in data analytics, healthcare consulting, HIPAA, healthcare information technology (HIT), and revenue cycle management. Her hands-on knowledge of Electronic Health Records (EHRs) further enhances her ability to deliver innovative solutions for UASI’s clients. "Lou Ann’s exceptional experience and commitment to lifelong learning align perfectly with UASI’s mission of providing outstanding healthcare solutions," said Nancy Koors, CEO of UASI. "Her leadership will undoubtedly drive our coding and auditing services to new heights, and we are thrilled to have her as part of the team." Lou Ann is also a seasoned speaker, author, and faculty member with a strong presence in the hospital and healthcare industry, making her a thought leader in the field. Her ability to guide teams through complex challenges and her focus on continuous improvement make her a valuable addition to UASI’s team. About UASI For over four decades, UASI Solutions has led the healthcare industry in revenue cycle management, providing tailored solutions to optimize fiscal performance and drive sustainable growth. Established in 1984, our commitment to innovation and client success has solidified our position as trusted partners nationwide. With a comprehensive suite of services, including Remote Coding, Clinical Documentation Improvement, and Revenue Integrity, we remain dedicated to delivering value and driving results for our clients every step of the way. For more information, please visit www.uasisolutions.com .

Healthcare is evolving, and as we move forward with quality care and compassion, it’s crucial to address the factors that significantly impact patient outcomes beyond traditional medical care. Social determinants of health (SDoH) are these non-medical factors—such as access to food, stable housing, transportation, and utility services—that influence a person's overall health and treatment outcomes. By effectively addressing and coding these determinants, providers can enhance care while also accessing additional reimbursement opportunities. CMS Strategic Plan “The Centers for Medicare & Medicaid Services (CMS) infuses health equity in everything it does. CMS is working to advance health equity so that each person has a fair and just opportunity to attain their highest level of health regardless of their age, race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” CMS wants to make sure that all individuals and families have access to quality healthcare. To do this CMS has to remove the barriers to healthcare and support and partner with providers to ensure that every person and family can access care they need. Starting in January 2024, CMS began offering coverage for HCPCS code G0136. This coverage allows providers to be reimbursed when they use a standardized, evidence-based SDoH risk assessment tool that evaluates crucial areas such as food insecurity, housing instability, transportation needs, and utility difficulties. To comply with G0136, providers must use validated tools that have been independently tested. The 2024 MPFS final rule specifies some approved tools, including: CMS Accountable Health Communities Tool Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE) Medicare Advantage Special Needs Population Health Risk Assessment The key is to find a tool suitable for your practice’s patient population while ensuring it meets CMS requirements. Documentation of the tool used in the patient record is also critical. Hospital Outpatient Quality Reporting Program (OQR) CMS is expanding its focus on SDoH beyond inpatient settings. The Hospital Outpatient Quality Reporting Program (OQR), a pay-for-reporting quality program, requires hospital outpatient departments to meet specific quality reporting requirements. Failure to do so results in a 2% reduction in their annual payment update. CMS is proposing to adopt the screening of Social Drivers of Health measure, with voluntary reporting starting in CY 2025, followed by mandatory reporting beginning in CY 2026. This expansion reflects CMS’s recognition of the importance of social factors in shaping health outcomes. It provides healthcare providers with the tools to identify at-risk populations and develop targeted interventions. The Commitment to Health Equity measure further encourages healthcare organizations to integrate equity into their strategic and operational goals, fostering a culture of accountability and continuous improvement. Expanded Reimbursement Opportunities CMS is committed to advancing health equity and has included measures to support providers and hospitals in addressing social drivers of health. For example, the new policy finalized for FY 2024 recognizes the higher costs that hospitals face when treating patients experiencing homelessness or housing insecurity. This policy introduces new codes effective from October 1, 2024, which will be classified as complications or comorbidities (CCs), thus increasing reimbursement for specific diagnosis-related groups (DRGs). These codes include: Z59.10 (Inadequate housing, unspecified) Z59.11 (Inadequate housing, environmental temperature) Z59.12 (Inadequate housing, utilities) Z59.19 (Other inadequate housing) Z59.811 (Housing instability, housed with risk of homelessness) Z59.812 (Housing instability, housed, homelessness in past 12 months) Z59.819 (Housing instability, housed, unspecified) Real-World Scenarios: How SDoH Coding Can Make a Difference Here are some examples where documenting SDoH impacts patient care and enhances reimbursement: A patient is diagnosed with hypothermia, and the physician documents that their home does not have heating. Code: Z59.11 (Lack of heating). A child’s record shows a history of food insecurity due to financial difficulties at home, leading to hunger. Code: Z59.48 (Lack of food). A patient misses multiple appointments due to transportation issues. Code: Z59.82 (Lack of transportation). A patient becomes homeless following the foreclosure of their home. Code: Z59.819 (Housing instability). Why This Matters for Your Practice Incorporating SDoH documentation not only improves patient care but also opens up significant reimbursement opportunities. UASI is here to guide you through these changes and help your practice implement these assessments seamlessly. Our expertise ensures your compliance with the latest CMS guidelines, helping you maximize reimbursement potential while enhancing patient outcomes.  Take Action Today Don’t let your practice fall behind in leveraging these opportunities. Contact UASI to learn how our clinical documentation and coding solutions can empower your practice to succeed. Together, we’ll build a more equitable, efficient, and effective healthcare environment for your patients.

This is a short synopsis of a possible patient record and is not intended to be all-inclusive. This is for educational purposes only and not intended to replace your institutional guidelines.

Fee-for-Service (FFS) vs. Value-Based Care (VBC): Understanding the Shift in Healthcare Compensation Models

When you think about coding in your organization, do you consider it a cost center? Often, the direct costs such as salaries, benefits, and equipment dominate the conversation. But what if we shifted the focus to understanding coding as an essential investment in your healthcare operations rather than just another expense? Beyond the Obvious Costs: The Hidden Impact of Coding We often focus on direct costs, but it’s easy to underestimate the indirect ones that quietly accumulate. Supervisory time, for example, is often overlooked as an indirect cost. Recruiting, testing, and turnover contribute further, along with quality assurance, ongoing education, and training. With every regulatory change and code-specific nuance, the demands increase—requiring more time, resources, and money. These factors don’t just affect your bottom line; they can significantly impact your Return on Investment (ROI) in ways that are frequently underestimated. The Real ROI of Accurate Coding The accuracy of your coding has a direct influence on your organization's financial health. Consider this: what would a mere 1% increase in coding accuracy mean for your top line? Not only could it boost revenue, but it could also reduce re-work costs and significantly cut down on denials. A lower denial rate means faster cash flow, less time spent on rework, and fewer headaches. Many systems often handle coding internally, focusing only on the direct costs. However, this approach overlooks not only the significant indirect costs—like supervisory time and training—but, more importantly, the impact on accuracy and productivity. These hidden factors can make a big difference in overall performance, which is why outsourcing your coding can provide a more efficient and accurate solution.  *“If you are questioning to remain in-house or outsource, it is imperative that you consider all costs and rewards – coding was costing me about $400k per month in lost revenue due to improper coding and lost charges (on $116m gross revenue, now $230m, so it would be higher).” Shifting Focus: From Administration to Patient Care What if your team could focus on what really matters—patient care—without the administrative burden of coding? Imagine the impact on your organization if you could shift the focus from managing coding staff and processes to enhancing patient outcomes. 6 Key Reasons to Outsource Your Coding Outsourcing your coding might be the game-changer your organization needs. Here’s why: Coder Shortage: The ongoing shortage of experienced coders, exacerbated by factors like ICD-10 implementation and the COVID-19 pandemic, makes finding and retaining qualified staff increasingly difficult. Quality and Productivity Demands: With evolving healthcare technology and constant regulatory changes, coding has become more complex. Meeting productivity and quality standards is challenging, especially for in-house teams. Fluctuating Workloads: Your coding needs fluctuate, but your costs don’t have to. Outsourcing allows you to scale up or down based on demand, saving you from the expenses of overstaffing or temporary hires. Geographical Challenges: Whether you're in a rural area or an underserved urban zone, outsourcing circumvents the difficulties of local recruitment by offering a broader talent pool. Improved Data Outcomes: Accurate and efficient coding is crucial for improving key data metrics that impact your organization’s reputation and reimbursement. By outsourcing your coding, you can enhance outcomes related to Health Grades, Quality Scores, CMS Star Ratings, and Risk Adjustment Factor (RAF) scores. Financial Relief: Outsourcing reduces the burden of managing an internal coding department. It cuts costs associated with recruitment, education, training, and retention, allowing you to focus resources where needed—patient care—and improves your overall ROI. *“We know it takes at least 18 months to get a coder proficient and accurate. I know our cost of labor is extremely high and would cost us considerably more per FTE when opportunity costs are calculated (lost revenue due to coding errors, missed charges, education, CDI, etc.)” Challenges and Opportunities: Beyond Just Numbers It’s not only about costs. The workforce is changing, and managing people is becoming harder. Burnout among coding staff is real, and it’s a growing concern that impacts both productivity and quality. Additionally, the coding workforce is aging, with many experienced coders approaching retirement. This looming wave of retirements is likely to exacerbate existing staffing challenges, making it even more difficult to maintain a fully staffed and skilled team. Continuous learning and development aren’t just nice-to-haves—they’re critical to success. As the demands on your coding team increase, are your leaders equipped to manage these challenges? UASI’s Solution: Experience and Expertise at Your Service This is where UASI comes in. With over 40 years of experience, we’ve honed our processes to deliver better results at the same or even lower cost than maintaining an in-house team. Here’s how we can transform your operations: • Reduced Headaches: We take on the challenges of recruiting, training, and managing coding staff, so you don’t have to. • Flexibility and Expertise on Demand: We provide the expertise you need when you need it, allowing you to scale up or down based on your coding demands. • Shared Success: We work as partners, with a focus on shared success and accountability. • Focus on What Matters: Our services free up your team to focus on patient care, reducing in-house tension and administrative strain. Highlighting the Benefits of Outsourcing Coding *“With a coding outsource, organizations do not need to spend money, time, and resources in hiring, training, and retaining experienced coders. Outsourcing is a cost-effective solution to reducing an organization’s administrative costs, as well as decreasing the administrative strain in the HIM department. In consideration of a coding outsource, it’s important to develop a cost-benefit analysis as well as determining appropriate, reportable KPIs.” “As I make changes to the RCM, one constant will be UASI because of their expertise and because of how they work with everyone on my side to effectively train my staff and to educate my providers.” Proven Outcomes: A Client Success Story Outsourcing of coding services has shown remarkable outcomes in terms of improved efficiencies and financial performance. Here are some notable results from a specific outsourcing client: • Decrease in DNFB by 44% in 90 days • Decrease in DNFC by 64% in 90 days • Nearly 100% decrease in front-end claim edits, with coders resolving edits concurrently at the time of coding, leading to an increase in clean claims being released for billing sooner. • Increased productivity, with all coders meeting or exceeding established productivity standards. • Improved efficiency of the organization’s HIM staff, allowing them to focus on resolving EMR issues, obtaining needed provider documentation, addressing chargemaster issues, and other registration and billing challenges. Outsourcing guarantees a qualified team to manage and perform the daily work associated with all coding needs, leading to measurable outcomes like improved DNFC and DNFB, enhanced coding quality, decreased coding edits, reduced denials, improved cash flow, and overall increased departmental efficiency. Flexible Engagement Models: Designed for Your Success At UASI, we offer two flexible ways to engage with our services: • Monthly Subscription Fee to Shared Success Fee: We start with a straightforward monthly subscription, transitioning to a shared success fee model after six months. This approach allows for a seamless transition to outsourcing, where we can re-badge your existing staff where appropriate. After the initial period, we evaluate the success of the engagement, ensuring it aligns with your goals and expectations. • Quick Results and Strategic Planning: Our model enables you to take quick action and see results rapidly. We begin with a thorough assessment to identify potential opportunities, propose a combination of a monthly fee and a shared success model, and allow your health system to evaluate the program for optimization. This data-driven approach ensures that you can determine the best path forward based on both strategy and measurable outcomes. These flexible engagement models are crafted to provide immediate benefits while allowing you to refine your strategy over time. By partnering with UASI, you can be confident in a solution that meets your organization's specific needs, enabling you to focus on what matters most—delivering exceptional patient care while achieving financial success. *CEO, West Coast Health System