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Exceptional Coders | Innovative Technology

The FY2019 ICD-10-CM Code Changes Have Been Released – Are YOU Prepared?

Posted by David Fong on Jul 13, 2018 6:00:00 AM

The Centers for Disease Control and Prevention (CDC) released the fiscal year (FY) 2019 ICD-10-CM (diagnosis) code changes last month. There are 473 code changes beginning October 1, 2018. They include 279 new codes, 143 revised codes, and 51 deactivated codes, according to the CDC website. In addition, there were 39 additional changes added from the proposed rule (list). The ability to code properly to these new and revised codes starting October 1 can make the difference in getting clean claim and being paid quickly or needless reimbursement delays.


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Topics: Medical Coding, Clinical Documentation, Outsourcing

Outsourced Clinical Documentation Functions Enhance Patient Care and Healthcare Revenue

Posted by David Fong on Jun 21, 2018 7:30:00 AM

Clinical documentation improvement (CDI) ensures that health services are accurately documented and helps healthcare coders and physicians work toward improved patient care, while also streamlining productivity. When meaningful clinical data is captured, organizations can ensure improved quality reporting, clinician productivity, and even better – accurate clinical information is delivered at the point of care.

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Topics: Medical Coding, Clinical Documentation, Outsourcing

OIG Sample Finds that More than 60% of Therapy Claims Don’t Meet Medicare Requirements

Posted by David Fong on Jun 8, 2018 6:00:00 AM

A recent article in Skilled Nursing News reported that more than 60% of outpatient therapy claims filed over a six-month period didn’t meet Medicare’s requirements — a figure that has a key government watchdog agency concerned.

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Topics: Medical Coding, Outsourcing, Coding Denial Management

Don’t Lose Potential Revenue Due to Staffing Errors

Posted by David Fong on May 24, 2018 6:00:00 AM

A recent article in the Chicago Tribune reported that the Cook County Health and Hospitals System lost an estimated $165 million or more in potential revenue over the past three years due to lax clerical procedures and employee errors.


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Topics: Medical Coding, Outsourcing, Coding Denial Management

The Rising Costs of Healthcare Billing

Posted by David Fong on May 8, 2018 6:00:00 AM

A recent study reported in a Los Angeles Times article found that healthcare in the United States is very expensive. One of the contributing reasons is that managing healthcare bills is really expensive. How expensive? At one large academic medical center, the cost of collecting payments for a single primary care doctor is upward of $99,000 a year.


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Topics: Medical Coding, Clinical Documentation, Outsourcing, Coding Denial Management

Accurate Coding and Documentation Are Critical in Today’s Value-Based Care Environment

Posted by David Fong on Apr 24, 2018 6:00:00 AM

At the American College of Cardiology’s Cardiovascular Summit in February, one presenter's PowerPoint slide showed how much proper documentation and coding could affect a hospital’s quality measures and bottom line.

 

Reported in Cardiovascular News, Linda Gates-Striby used a hypothetical example of a 76-year-old woman with diabetes and heart failure. If clinicians only documented basic information about this patient, her expected cost of care per month would be in the ballpark of $5,000. But by coding more specific designations for the diabetes and heart failure—and noting an interaction between the conditions—the total risk score value would balloon to $13,554 per month.

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Topics: Medical Coding, Clinical Documentation, Outsourcing

Overcoding and Overbilling: Two Problems with an Easy Solution

Posted by David Fong on Apr 3, 2018 8:00:00 AM

A recent article in Medical Economics pointed out a persistent problem that some physicians continue to overcode and overbill, despite increased focus on the cost of healthcare and scrutiny by federal regulators.  According to the article, a new report by ProPublica, which analyzed CMS data between 2012 to 2015, a number of physicians overcoded on services provided under Medicare’s Part B program.

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Topics: Medical Coding, Coding Compliance, Medical Coding Audits, Outsourcing

Aviacode Joins AHIMA in Celebrating Health Information Professionals Week 2018

Posted by David Fong on Mar 20, 2018 11:15:00 AM

Aviacode joins American Health Information Association (AHIMA) in celebrating health information professionals during the 29th annual Health Information Professionals (HIP) this week (March 18–24, 2018).

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Topics: Medical Coding, Medical Coders, Health Information Management, Medical Coding Audits

Proposed CMS Risk-Adjustment Changes Could Lower Medicare Advantage Revenue

Posted by David Fong on Mar 9, 2018 12:30:00 PM

Modern Healthcare reported in a recent article that health insurer and provider groups were complaining about the CMS' proposal to use more patient encounter data to determine Medicare Advantage plans' risk scores in 2019, saying the data could reduce payments for plans.

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

KLAS Outsourced Coding 2018 Report Shows an Increasingly Competitive Market with 54% of Providers Maintaining or Increasing Their Outsourcing

Posted by David Fong on Feb 28, 2018 6:00:00 AM

The medical coding industry has evolved since the mandate of ICD-10 on October 1, 2015.  There were concerns of increased backlogs, first-pass denials, and hiring challenges.  That wave of concerns has given way to a maturing outsourced coding industry.

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Topics: Medical Coding, HIM, Outsourcing