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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

Mammography Coding Changes Highlighted During Breast Cancer Awareness Month

Posted by David Fong on Oct 17, 2019 7:00:00 AM

October is Breast Cancer Awareness Month.  As part of the overall push for mammogram screening and self-checks, there are also calls for practices to ensure they are coding properly for Medicare-provided mammograms. According to a recent AAPC blog post written by Barbara Aubry, RN, AAPC fellow, there are several important ICD-10-CM updates, recently deleted codes, and updates for 2020. These updates began on October 1st for FY 2020.

 

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

Be Prepared for the ICD-10-CM Coding Changes for FY 2020

Posted by David Fong on Jul 31, 2019 6:00:00 PM

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.

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Topics: ICD-10, Medical Coding

Medical Coding Certifications

Posted by Ben Castleberry on Jun 4, 2016 6:30:00 AM

 

If you are considering having a serious career in medical coding, the first thing you need to do to gain credibility is to get certified. There are several different types of certifications for medical coders so make sure you know which one would be best for you. The certifications are split into two different levels: entry- level certifications and advanced certifications. Here are some of the most popular certifications:

 

Entry-level Certifications

 

Certified Coding Associate (CCA)

This is offered through AHIMA and is one of the most basic certifications that they offer. The program is designed to give medical coders a general understanding of coding principles. It will create coding competency in both hospitals and physician practices.

            Eligibility Requirements:

  • High School Diploma

            Eligibility Recommendations:

  • 6 months of medical coding experience
  • Completion of an AHIMA approved coding program

 

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Topics: ICD-10, Medical Coding, HIM

3 Ways to Prevent Revenue Leakage in Healthcare

Posted by Ben Castleberry on May 31, 2016 8:57:26 AM

Your practice will experience revenue leakage starting the moment a patient schedules an appointment with you. Some of these leaks typically start out small but overtime they will make large dents within your practice. Below are some tips to help improve your rev cycle management system and prevent those leaks.

 

  1. Patient Information: Acquiring accurate patient information will help reduce claim rejections due to ineligibility, patient not found, or service not authorized. Implement a checklist at your practices registration office to help insure accuracy. The staff member registering a patient should verify the patient’s information, take a photocopy of the patient’s insurance card, and review the patient’s insurance (optimally, this would be done before the physician sees the patient in order to avoid performing services that are not covered).

 

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Topics: ICD-10, Medical Coding, HIM

5 Common E/M Coding Errors to Avoid

Posted by Ben Castleberry on May 25, 2016 8:45:55 AM

 

E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. There is a fine line to walk when it comes to Medical coding.  Frequent E/M coding errors occur when medical practices are either upcoding or undercoding. Upcoding increases the risk of audits. Coding too conservatively doesn’t protect your practice from audits, and it severely decreases your level of reimbursement. Here are some tips to help you stay on the straight and narrow:

 

  1. Sending out Claims Under the Wrong Provider: Popular medical coding errors occur when nurse practitioners and physician assistants report services improperly. Often times NP’s or PA’s will send out claims under the physician’s name and National Provider Identifier, but if the patient was treated solely by the NP or PA, the claim should be billed under the mid-level practitioner’s name and NPI.

 

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Topics: ICD-10, Medical Coding, HIM

Who Participates in Medical Coding

Posted by Ben Castleberry on May 13, 2016 6:00:00 AM

Who Participates in Medical Coding?

Coding is a team effort, with the certified medical coder leading the way.

 

Front Desk/Receptionist

Medical coding starts with a patient making an appointment to see their physician. The receptionist makes the appointment – without the appointment the coding process would fail to start.

 

Physician or Healthcare Provider

Next, is the physician, or healthcare provider. They diagnose the patient based on their symptoms (complaints), and in some cases blood tests, x-rays, or any number of other test(s).

 

Certified Medical Coder

Then the medical record makes its way to the certified medical coder. The coder translates the written clinical documents into codes. This coding process allows the physician or healthcare provider to receive payment for the services they have provided to the patient.

 

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Topics: ICD-10, Medical Coding, HIM

A Brief History of Medical Coding

Posted by Ben Castleberry on May 11, 2016 8:30:00 AM

The medical coding system originated in England during the 17th century. Statistical data was collected from a system called the London Bills of Mortality, and the data was organized into numerical codes. The codes were then used to estimate the most recurrent causes of death. 

 

Fast-forward a few centuries… The statistical examination of the Mortality Rate (causes of death) was then organized into the “International List of Causes of Death.” Over the years, the World Health Organization (WHO) used the list increasingly to help in tracking the mortality rates and the international health developments.

 

The list was later developed into the International Classification of Diseases, which is now in it’s 10th edition, also known as the ICD-10-CM/PCS.

 

In 1977, the global medical community accepted the ICD system, which compelled the National Centers for Health Statistics (NCHS) to expand their reach to contain clinical information. In other words, the ICD system was extended to include cause of death and clinical diagnoses, such as injuries and illnesses.

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Topics: ICD-10, Medical Coding, ICD-9