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Exceptional Coders | Innovative Technology

Ninety-three Percent of Healthcare Executives Are Seeking Improved Data Analytics and CDI

Posted by David Fong on Dec 13, 2018 8:05:00 AM

Healthcare IT Analytics reported recently that healthcare executives are on the hunt for improved data analytics, and many are turning to clinical documentation improvement programs to enhance data quality and integrity. Healthcare organizations looking to improve the quality of their data assets are actively seeking ways to leverage data for clinical analytics and population health management, according to a new poll from Black Book.

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Coding Quality Assurance Is Universal

Posted by David Fong on Nov 28, 2018 8:09:07 AM

Whether you are coding with domestic staff or offshore staff, the quality of medical coding is dependent on the rigors of the quality assurance program you have in place, not where your coders reside or work.  A 95 percent coding quality standard is the same regardless of the choice of locale when applied equally.

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DaVita Subsidiary Settles Risk Adjustment Billing Case for $270 Million

Posted by David Fong on Nov 15, 2018 8:00:00 AM

Modern Healthcare reported recently that DaVita Medical Holdings will pay a $270 million settlement to the federal government over allegations that the company incorrectly inflated certain Medicare Advantage reimbursements above the fixed, risk-adjusted rate owed for care.

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Topics: Risk Adjustment, Medical Coding, Coding Compliance, Medical Coding Audits, HCC Coding

Responding to RCM Challenges and Weighing Decisions about Whether to Partner

Posted by David Fong on Oct 31, 2018 11:50:59 AM

In mid-September, healthcare revenue cycle and information technology executives gathered in Chicago to discuss the evolving nature of the hospital and health system revenue cycle and how they are responding to its challenges, disruptions and priorities according to Becker’s Hospital Review. The conversation was part of Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference.

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Topics: Becker's, Outsourcing, Healthcare, Coding Denial Management, Medical Coding

AMA Releases 2019 CPT Code Set

Posted by David Fong on Oct 12, 2018 3:44:47 PM

 The American Medical Association (AMA) announced in early September the release of the 2019  Current Procedural Terminology (CPT®) code set. There are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the health care community’s combined annual effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services.

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Topics: CPT code, AMA, Medical Coding

Federal Policies to Decrease Hospital Payments by $218B by 2028 – Are You Prepared?

Posted by David Fong on Sep 29, 2018 7:00:00 AM

Beyond the Affordable Care Act, regulatory changes and legislative acts will reduce hospital payments by over $218 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed.


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Topics: Medical Coding, Outsourcing, Medical Coding Audits

Maximize Coding Productivity By Bringing Professional and Facility Coding Together

Posted by David Fong on Sep 14, 2018 9:00:00 AM
Professional and facility coding represent different aspects of a healthcare visit. Hence, the longstanding tradition has been that many hospitals and health systems tend to keep the departments separate. For a growing West Coast-based health system, keeping a wall up between professional and facility coders meant double the work as the volume of claims increased.
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Topics: Medical Coding, Outsourcing, Medical Coding Audits

Prevent Medical Coding Fraud and Abuse Claims Before They Happen

Posted by David Fong on Aug 30, 2018 5:30:00 AM

According to the AMA’s Principles of CPT® Coding, ninth edition, as reported in the AMA Wire® newsletter, when it comes to medical coding errors, they fall into the broad categories of “fraud” and “abuse.” The former involves intentional misrepresentation. The latter means “the falsification was an innocent mistake, but nonetheless representative,” An example of abuse could involve coding “for a more complex service than was performed due to a misunderstanding of the coding system.”


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Topics: Medical Coding, Outsourcing, Medical Coding Audits

CMS Proposed Rule Reduces Evaluation and Management Coding Burden

Posted by David Fong on Aug 15, 2018 6:00:00 AM

The Centers for Medicare and Medicaid Services has released a proposed rule for the Calendar Year 2019 Physician Fee Schedule that purportedly reduces the corresponding burden of paperwork that clinicians face when billing Medicare, in order to enable them to spend more time taking care of patients. The initiative could greatly affect the time involved in using electronic health records and how clinicians interact with systems.


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Topics: Medical Coding, Outsourcing

Hospitals Now Allowed to Use Non-Physician Documentation to Support Coding for Social Determinants of Health

Posted by David Fong on Jul 26, 2018 7:00:00 AM

A recent Becker’ Hospital CFO Report  article noted the changing of the rules governing reporting of social determinants of health following the American Hospital Association's diligent work. The association said the ICD-10-CM Cooperating Parties, including AHIMA, AHA, CMS and the National Center for Health Statistics, approved advice published by the AHA Coding Clinic that allows hospitals to report ICD-10-CM codes included in categories Z55-Z65, based on documentation from all involved caregivers, including non-physicians. That change took effect in February of this year.


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Topics: Medical Coding, Outsourcing, Clinical Documentation