Exceptional Coders | Innovative Technology

October is Breast Cancer Awareness Month.  As part of the overall push for mammogram screening and self-checks, there are also calls for practices to ensure they are coding properly for Medicare-provided mammograms. According to a recent AAPC blog post written by Barbara Aubry, RN, AAPC fellow, there are several important ICD-10-CM updates, recently deleted codes, and updates for 2020. These updates began on October 1^st for FY 2020.

Major medical groups and hospitals have backed the CMS' decision to abandon a provision of the finalized 2019 Medicare Physician Fee Schedule rule that would have consolidated the number of Evaluation and Management (E/M) payment levels into one payment rate beginning in 2021. The agency initially proposed the E/M coding measure in the belief that it would reduce clinicians' work to get Medicare reimbursement. However, providers worried that lower reimbursement rates would cut into their bottom lines and create a number of unintended consequences that could hurt patients.

Managers of skilled nursing facilities are eagerly anticipating changes that will change the way they code, bill, collect data, and operate. A September 2019 article from McKnight’s Long-Term Care News details the long-awaited changes for long-term care reimbursements through the new Patient-Driven Payment Model (PDPM). The changes, which go into effect October 1, are revisions to the Resident Assessment Instrument (RAI), which is essentially the “rulebook” for Medicare and Medicaid reimbursements.

Claim denials can be crippling for providers. And they’re especially irksome when they’re caused by avoidable coding errors. Managing E/M coding modifiers and incident-to services properly are two areas that providers can greatly improve in order to avoid denials and obtain maximum revenue.

Medical coding problems arise in part when they result in payers spotting abnormalities in the claims information. This prompts an audit and discovery of overpayments, and the payer then takes steps to get that money returned. The provider suffers because they’ve used that money for payroll or equipment, and now their cash flow is disrupted. Repeated instances of such recoupments can result in significant dollar drain and additional future reimbursement scrutiny. 

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.