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Appeals Court Nixes Fraud Case, Affirms Health System's Coding & CDI Practices

Posted by David Fong on Jun 23, 2020 8:00:00 AM

Last month, the United States Court of Appeals for the Fifth Circuit affirmed a lower district court decision to dismiss a False Claims Act lawsuit brought against a Texas-based hospital system. The lawsuit by a data analytics firm accused the health system of fraudulently using secondary diagnosis codes to increase its revenues over a six year period.

 

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Topics: ICD-10, Medical Coding, HCC Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding

Medicare Payment Rates Announced for COVID-19 Test CPT Codes

Posted by David Fong on May 22, 2020 9:30:00 AM

More than 10 million COVID-19 laboratory tests have been conducted in the United States thus far. While the US testing per capita rate still lags behind several other countries, the number of tests completed continues to rise. These tests are medical coded and reimbursed just like other medical procedures. The CPT codes announced in March and April when testing became prevalent in the United States now have associated Medicare MAC payment rates.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19

Telehealth Usage Skyrocketing During This Pandemic

Posted by David Fong on Apr 23, 2020 9:30:00 AM

Telehealth usage is skyrocketing during this COVID-19 pandemic, as the way people interact with each other and their healthcare providers change. The increased demand in remote video technology, or in its absence telephony, for clinical interactions has led to changes in how providers offer patient care, as well as led to changes in reimbursement policies enacted and enforced by the federal government.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19

Medical Coding COVID-19 Challenges and Answers

Posted by David Fong on Mar 25, 2020 8:00:00 AM

The medical coding industry before COVID-19 made it easy for you. If you were outsourcing it was simply domestic versus global. Fast forward to this COVID-19 pandemic, the healthcare industry has been flipped on its head. Hospitals are expecting a surge in demand with an increasing number of testing, triage and positive COVID-19 patients needing hospitalization. This in the face of a short supply of hospital beds, ICUs, and ventilators, as well as temporary facilities being added as fast as possible. Medical coding is facing similar challenges to meet this growing demand.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding

People-Centered RCM to Bend the Healthcare Cost Curve

Posted by David Fong on Dec 18, 2019 8:00:00 AM

A recent Becker's Hospital Review article highlighted healthcare's significance in the American economy. In that, healthcare accounts for more than 17 percent of the nation's gross domestic product, employs more people than any other industry in the nation, and venture capital alone invested more than $23 billion in healthcare in 2018. The article points out that despite these massive investment and the efforts of a talented workforce, many of the nation's hospitals and health systems operate on razor-thin operating margins and face the dual challenge of achieving fiscal sustainability while delivering high quality care to patients.

 

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Topics: ICD-10, Revenue Cycle Management, Medical Coding, Pro-Fee Coding, Facility Coding

Physician Documentation and Coding Can Have Significant Provider Impact

Posted by David Fong on Nov 27, 2019 2:55:00 PM

A recent Forbes article entitled “Physician Documentation And Coding: The Third Rail? showcased the potential missed opportunities to fully understanding the correlation between physician documentation and coding and their resulting effects. Whereas patients may interpret documentation as a doctor providing an account of your visit in your medical record, providers have a far greater impact with documentation. Documentation and coding can affect revenue, quality of care, and potentially expose providers to legal compliance consequences.

 

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Topics: ICD-10, Medical Coding, Coding Compliance, Pro-Fee Coding, Facility Coding

CMS Latest Final Rule Updates Office/Outpatient E/M Coding and Documentation Policies

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

The Centers for Medicare & Medicaid Services (CMS) issued a final rule earlier this month that includes updates to payment policies and rates for services provided under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020, as well as updates to its E/M coding starting on January 1, 2021.

 

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Topics: ICD-10, Medical Coding, Coding Compliance, Pro-Fee Coding, Facility Coding

Healthcare Waste Eclipses U.S. National Defense Budget, Study Finds

Posted by David Fong on Oct 31, 2019 3:00:00 PM

The annual U.S. national defense spending budget represents a massive hard-to-imagine number. Now consider the amount of waste in the country’s healthcare system. Likely a large amount, but it must be less than national defense—right? According to a recent article on CBSNews.com titled “Wasted health care spending in the U.S. tops annual defense budget, study finds,” the healthcare waste actually exceeds the FY2019 national defense budget, and is estimated at $760 to $935 billion per year. This is waste on a scale that’s difficult to imagine. It’s about a quarter of the sum total of healthcare spending. The study referenced in the article is from the Journal of the American Medical Association, and details the immense scale of the problem.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding