Exceptional Coders | Innovative Technology

The Centers for Medicare & Medicaid Services recently announced updates for ICD-10-CM coding. Managing and keeping abreast of these codes are a complex undertaking, as there will be 72,184 codes in FY 2020. Healthcare organizations should strongly consider utilizing outside coding assistance to effectively understand the changes and benefits of the changes to ICD-10-CM.

Health systems are increasing merging in today's ecosphere with an increased push to improve bottom lines. Modern Healthcare recently interviewed CFOs from different sized health systems on a range of topics, including revenue cycle outsourcing.

The quality of coding, of course, largely determines how practitioners submit bills and the amount they’re paid. A dermatologist practice (or other provider) therefore must have confidence in the accuracy and timeliness of their coding. There are changes in the works for dermatology coding, as with all coding, and doctors and staff should proactively understand these changes and make the necessary adjustments in their coding procedures. There is no time like the start of summer with the increased risk of UV rays for this renewed attention to dermatology.

As healthcare finance leaders converge in Orlando next week for the annual Healthcare Financial Management Association (HFMA) Annual Conference, this recent HealthLeaders article highlights how to find the hidden dollars in your hospital (without reducing labor).

The United States Attorney’s Office District of Massachusetts recently announced that CareWell Urgent Care Centers has agreed to pay $2 million to resolve allegations they violated the False Claims Act by submitting claims to Medicare, MassHealth, GIC, and Rhode Island Medicaid that falsely inflated the level of E/M services performed and by failing to properly identify the providers of E/M services.

Astria Health, a Washington-based health system, filed for Chapter 11 bankruptcy protection earlier this month, as reported in Becker's Hospital Review. In its press release, the health system said it is facing a significant shortfall in cash flow due to issues with the company it contracted with to manage its billing in August 2018. Astria said the unidentified company failed to process a significant number of accounts receivable, leading to a backlog of unpaid claims, according to the Yakima Herald-Republic.

A key Medicare advisory panel, the Medicare Payment Advisory Commission (MedPAC), has formally called on the CMS to revisit creating a national guideline for coding emergency department visits.

A recent survey of 100 healthcare leaders within finance, revenue cycle, reimbursement, and health information management at hospitals and acute-care facilities sought to report on the areas of most-needed improvement within revenue cycle management. The results of the survey, by BESLER who partnered with HIMSS, found a significant majority of respondents -- 84% noted coding and clinical documentation as two areas of high or medium revenue cycle risk. Nearly half noted these two areas as their greatest vulnerability. Why are these two areas causing such concern among leaders and resulting in depleted revenues?

Coding audits, which are the validation of code assignment against the supporting clinical documentation and coding guidelines, are an instrumental way to ensure accuracy. Organizations usually conduct regular coding audits as directed by their internal compliance plan. They include a random sampling of records or encounters reviewed per coder during a specified timeframe, typically on an annual basis.

The Department of Justice announced in a press release last month that Skyline Urology has agreed to pay the United States $1.85 million to resolve allegations that it violated the False Claims Act by submitting improper claims to the Medicare program for evaluation and management services.