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Exceptional Coders | Innovative Technology

David Fong

Recent Posts

Revenue Cycle Outsourcing Continues with Focus on Accountability

Posted by David Fong on Jul 15, 2019 12:31:11 PM

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.

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Adapting to Changes in Dermatology Coding

Posted by David Fong on Jun 28, 2019 11:15:53 AM

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.

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Topics: Medical Coding

Find the Hidden Dollars in Your Hospital

Posted by David Fong on Jun 17, 2019 10:40:12 AM

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).

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Topics: Medical Coding, Denial Management

$2 Million Settlement Highlights Coding and Billing Fraud Problems

Posted by David Fong on May 29, 2019 11:05:18 AM

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.

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Topics: Medical Coding, CPT code

Health System Files for Bankruptcy Citing Revenue Cycle Vendor Issues

Posted by David Fong on May 14, 2019 4:15:28 PM

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.

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MedPAC Recommends CMS Change to ED Coding

Posted by David Fong on Apr 25, 2019 8:00:00 AM

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.

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Topics: ED Coding, EDPMA

84% of Industry Leaders Points to Coding and Clinical Documentation as Challenging Revenue Cycle Problems in Recent Survey

Posted by David Fong on Apr 16, 2019 9:00:00 AM

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?

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Topics: Medical Coding, CDI

Auditing Process More Meaningful than a Random Sample Selection

Posted by David Fong on Mar 29, 2019 1:13:17 PM

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.

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Topics: Clinical Documentation, Medical Coding Audits

Physician Group to Pay $1.85 Million to Settle False Claims Act Allegations of Medicare Overbilling

Posted by David Fong on Mar 16, 2019 4:00:00 PM

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.

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Topics: HCC Coding, Risk Adjustment

Mid-Revenue Cycle Management Market Heating Up

Posted by David Fong on Feb 28, 2019 3:35:45 PM

Mid-revenue cycle management is concerned with the phase of the process between the point where a patient accesses care and the care provider’s business office. Typically processes during this time include documentation, coding, CDI, and compliance. A recent Markets and Markets report  expected sustained growth in this market. It projects a compound annual growth rate (CAGR) of 7.9 percent and a market size of $4.5 billion by 2023.

 

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Topics: Revenue Cycle Management, Medical Coding, Clinical Documentation, CDI