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.
Big Changes for Long-Term Care Coding and Billing with New PDPM Rules
Managing E/M Modifier and Incident-to Services Coding
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.
Check Your E/M Coding to Avoid Costly Recoupments
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.
Topics: Medical Coding
Be Prepared for the ICD-10-CM Coding Changes for FY 2020
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.
Revenue Cycle Outsourcing Continues with Focus on Accountability
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.
Adapting to Changes in Dermatology Coding
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.
Topics: Medical Coding
Find the Hidden Dollars in Your Hospital
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).
$2 Million Settlement Highlights Coding and Billing Fraud Problems
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.
Health System Files for Bankruptcy Citing Revenue Cycle Vendor Issues
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.
MedPAC Recommends CMS Change to ED Coding
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.