October 1, 2017 introduced the mandated code updates for thousands of FY 2018 ICD-10-CM and ICD-10-PCS codes. Necessary code changes must be incorporated into every hospital, physician practice, medical provider, payer billing, and abstracting system, and/or encoder.
Topics: Medical Coding
As you are well aware, Congress created Medicare Advantage (MA) as a risk adjustment payment program that pays insurers more for sicker beneficiaries. Payers in MA receive a yearly fee for each enrolled member and monthly risk adjustment payments for each enrolled beneficiary, based partly on the person’s health status. This program can be open to fraud. Medicare Advantage payers received about $160 billion in 2015 for approximately 16 million beneficiaries. HHS estimates that the FY 2015 Medicare Part C gross improper payment estimate is 9.50 percent or $14.12 billion, along with the FY 2015 net improper payment estimate of 4.32 percent or $6.41 billion.
Aviacode joins AHIMA in celebrating and showing our appreciation for all the outpatient coding professionals during the month of September.
An article in Modern Healthcare magazine reported that physicians who serve low-income patients with complex conditions are more vulnerable to financial losses in value-based payment models. The study that found these providers, many of them safety-net providers, didn't have the technological infrastructure to report the necessary data.
A recent Managed Healthcare Executive magazine article entitled: “Five ways to reduce healthcare administrative costs,” identifies five strategies that healthcare executives can use to reduce onerous administrative costs. According to the article, administrative costs make up about 15 percent of all healthcare expenditures -- well over $300 billion annually, as found in the 2016 index report from the California Association for Healthcare Quality. Outdated, manual processes and rejected claims eat up a large portion of this administrative cost.
Medicare Advantage (MA) is a complex program that continues to gain popularity, with about one-third of Medicare beneficiaries currently enrolled in a variety of MA programs. MA plans are issued by MAOs, or Medicare Advantage Organizations, that are typically insurance companies.
Not only is clinical documentation improvement (CDI) the key to better ICD-10 coding and reimbursement accuracy, but it's also vital for preparing healthcare organizations for the new care paradigm of population health management. To this end, AHIMA has designated the month of July as CDI Month with Aviacode joining in the recognition to CDI professionals nationwide.
There are two key players in revenue cycle stream – the HIM coding department and the patient financial services department. Working together these two departments can sustain a healthy revenue cycle for any healthcare organization. These two departments are responsible for all of the basic elements of the revenue cycle -- from registration to coding the care provided to final discharge.
Patient financial services, typically, includes the registration process, and that is where the revenue stream has its head waters. An accurate registration process establishes the basis for future follow-up with payers or the patient as a self-payer.
Using their knowledge of billing rules, patient financial services applies the appropriate billing rules, such as Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) to produce an accurate patient bill.
The HIM coding department uses its vast knowledge of the very latest coding rules to provide patient financial services with an accurate medical record from which to produce their patient bill.
If you prefer clerical tasks over clinical duties, becoming a medical coder is a great way to get involved in the healthcare industry, especially since there are increasing opportunities for employment. The primary duties of a medical coder are to translate medical records into industry standard code. These medical codes are then sent to insurance agencies, government programs, and other organizations. Coding accurately helps healthcare organizations be reimbursed for services they perform, while failing to code adequately will greatly defect institutions’ financial stability.
In order to begin a career in medical coding the first thing to do is to become certified. Some certifications require different coding experience, others require some form of college education, while some certifications have no requirements for eligibility. Medical Coding Certifications
The best medical coding certification programs will usually include:
- Training on HIPAA
- Medical Terminology
- Anatomy and Physiology
- ICD-10 (diagnostic coding)
- CPT (procedural coding)
- Coding Software Programs
- Healthcare reimbursement methodologies
Topics: Medical Coding
The world of healthcare is currently undergoing many changes. One of them being the switch to value based care. Below are some trends successful organizations have implemented to keep up with it all.
Merging healthcare organizations has become and will continue to be a popular choice for many organizations. The healthcare world is all about acquiring patients. One of the best methods to increase a hospitals patient base is to be involved in a merger. Bigger hospitals are more likely to be successful by providing patients with more affordable services. Small organizations will likely stay in a fragile state.
- Technology Advancements
Technology is always advancing. Even though most organizations have implemented different types of technology into their systems, there will always be improving systems that arise. Below are some new technology trends that will be affecting the healthcare world in 2016.
Health Monitoring Devices
It has become quite a popular trend for the public to monitor aspects of personal health by wearing Fit Bits or other similar devices. This can greatly impact and improve patient care. Hopefully people using these devices will be able to pay more attention to their health, and the limitations their body has. When patients are familiar with their vitals, exercising habits, and sleep patterns it may help doctors come up with more accurate diagnoses.