Revenue cycle issues such as coding, charge capture, and denials management are among the top risk areas for healthcare organizations in 2019, according to a report from Crowe, a public accounting, consulting and technology firm.
Coordinated Health and its founder and CEO entered recently into an agreement with the federal government to settle False Claims Act allegations, according to the Department of Justice. The health system will pay $11.25 million and founder and CEO Emil Dilorio, MD will pay $1.25 million to settle the allegations. In addition to the monetary settlement, the system entered into a corporate integrity agreement with HHS that will require monitoring of its billing practices for five years.
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.
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.
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.
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.
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.
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.
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.
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.”