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Exceptional Coders | Innovative Technology

Adapting to Changes in Dermatology Coding

Posted by David Fong on Jun 28, 2019 11:15:53 AM

The quality of coding, of course, largely determines how practitioners submit bills and the amount they’re paid. A dermatologist practice (or other provider) therefore must have confidence in the accuracy and timeliness of their coding. There are changes in the works for dermatology coding, as with all coding, and doctors and staff should proactively understand these changes and make the necessary adjustments in their coding procedures. There is no time like the start of summer with the increased risk of UV rays for this renewed attention to dermatology.

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Topics: Medical Coding

Find the Hidden Dollars in Your Hospital

Posted by David Fong on Jun 17, 2019 10:40:12 AM

As healthcare finance leaders converge in Orlando next week for the annual Healthcare Financial Management Association (HFMA) Annual Conference, this recent HealthLeaders article highlights how to find the hidden dollars in your hospital (without reducing labor).

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Topics: Medical Coding, Denial Management

$2 Million Settlement Highlights Coding and Billing Fraud Problems

Posted by David Fong on May 29, 2019 11:05:18 AM

The United States Attorney’s Office District of Massachusetts recently announced that CareWell Urgent Care Centers has agreed to pay $2 million to resolve allegations they violated the False Claims Act by submitting claims to Medicare, MassHealth, GIC, and Rhode Island Medicaid that falsely inflated the level of E/M services performed and by failing to properly identify the providers of E/M services.

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Topics: Medical Coding, CPT code

84% of Industry Leaders Points to Coding and Clinical Documentation as Challenging Revenue Cycle Problems in Recent Survey

Posted by David Fong on Apr 16, 2019 9:00:00 AM

A recent survey of 100 healthcare leaders within finance, revenue cycle, reimbursement, and health information management at hospitals and acute-care facilities sought to report on the areas of most-needed improvement within revenue cycle management. The results of the survey, by BESLER who partnered with HIMSS, found a significant majority of respondents -- 84% noted coding and clinical documentation as two areas of high or medium revenue cycle risk. Nearly half noted these two areas as their greatest vulnerability. Why are these two areas causing such concern among leaders and resulting in depleted revenues?

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Topics: Medical Coding, CDI

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

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