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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

Revenue Optimization: Medical Coding and Documentation

Posted by David Fong on Feb 15, 2019 6:30:00 AM

By optimizing revenue healthcare, organizations can put themselves in a position to survive and thrive in the modern marketplace of shrinking margins, consumer engagement, and higher cost pressures. This is true whether you are affiliated with billing companies, hospitals, physician practices, or payers. One of the most important ways to optimize revenue is by ensuring accuracy and efficiency in medical coding and documentation.

 

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Topics: Medical Coding, Clinical Documentation, HCC Coding, Medical Coding Audits

DOJ Joins Whistleblower Lawsuit Accusing Health System of Submitting Unsupported Diagnosis Codes

Posted by David Fong on Jan 31, 2019 8:00:00 AM

As the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily grown to over 19 million beneficiaries according to a U.S. Attorney, federal prosecutors intervening in a newly unsealed whistleblower lawsuit in California is yet another example of the government's willingness to protect the integrity of the Medicare Advantage program through the courts.

 

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

The Top Risk Areas for Healthcare Organizations in 2019

Posted by David Fong on Jan 15, 2019 9:00:00 AM

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.

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Topics: Medical Coding, Medical Coding Audits, Coding Denial Management

The Value of Outside Coding Consultants

Posted by David Fong on Dec 31, 2018 11:39:36 AM

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.

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Topics: Clinical Documentation, Coding Compliance, Outsourcing

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

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