A recent Kaufman Hall survey found that an overwhelming majority of healthcare executives (96 percent) stated that cost transformation is a significant need for their hospital or health system. Yet, over 50 percent of organizations surveyed either do not have a healthcare cost reduction goal or have such a small goal that it will not, in reality, transform their cost structures.
A recent Becker’s Hospital Review article stated that Catholic Health had agreed to pay $6M to settle overbilling allegations. A nursing home subsidiary of the health system allegedly submitted claims to Medicare for the highest and most expensive levels of therapy when that type of therapy was not medically necessary or was unsupported by medical records. The allegations against Catholic Health were originally brought by a whistle-blower under the qui tam provision of the False Claims Act.
The medical sector has been undergoing a series of interminable changes over the last few years. In consequence, healthcare revenue cycle management (RCM) market is set to witness a marked growth because of the rising need for timely bill reimbursements and insurance claims. Increased complexity in the medical coding process has led to the necessity of RCM solutions that help reduce billing errors.
Almost three-quarters of struggling hospitals are re-prioritizing revenue cycle management over a number of other initiatives. A recent Black Book Market Research survey uncovered that hospitals leaders are pushing revenue cycle management to the top of their priority lists in this last quarter of 2017. The Black Book Research indicated that 74 percent of struggling hospitals are putting population health, analytics, physician practice acquisitions and recruitment, and patient engagement on the back burner to reprioritize revenue cycle management through Q4 2017.
A recent nationwide ICD-10 coding accuracy and productivity contest by Central Learning demonstrates the fact that the medical coding industry still needs to greatly improve in order to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level. Although there was a slight improvement in inpatient and emergency department accuracy, the ambulatory surgery accuracy score decreased. The average inpatient coder accuracy was 61 percent and the average outpatient coder accuracy was 41 percent.
The Advisory Board Company in a press release earlier this year announced that the average 350-bed hospital has an overlooked opportunity of up to $22 million in revenue capture. Improving revenue cycle performance to decrease missed revenue opportunity means responding to four market forces.
A recent Black Book Market Research survey indicated that the outsourced coding and Health Information Management market is expected to double in 2018. Within this survey, Aviacode was once again ranked among the top vendors in outsourced coding.
This year's new ICD-10 coding changes affect many different medical specialties. Here a just a few of the changes for some medical specialties as listed from CMS.gov.
Be sure to check the complete files to see the details on the changes that will affect your specialty. To view the changes, download the Addendum from the CMS 2018 ICD-10-PCS and GEMs page. Go to https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-PCS-and-GEMs.html
Topics: Medical Coding
October 1, 2017 introduced the mandated code updates for thousands of FY 2018 ICD-10-CM and ICD-10-PCS codes. Necessary code changes must be incorporated into every hospital, physician practice, medical provider, payer billing, and abstracting system, and/or encoder.
Topics: Medical Coding
As you are well aware, Congress created Medicare Advantage (MA) as a risk adjustment payment program that pays insurers more for sicker beneficiaries. Payers in MA receive a yearly fee for each enrolled member and monthly risk adjustment payments for each enrolled beneficiary, based partly on the person’s health status. This program can be open to fraud. Medicare Advantage payers received about $160 billion in 2015 for approximately 16 million beneficiaries. HHS estimates that the FY 2015 Medicare Part C gross improper payment estimate is 9.50 percent or $14.12 billion, along with the FY 2015 net improper payment estimate of 4.32 percent or $6.41 billion.