Coding audits, which are the validation of code assignment against the supporting clinical documentation and coding guidelines, are an instrumental way to ensure accuracy. Organizations usually conduct regular coding audits as directed by their internal compliance plan. They include a random sampling of records or encounters reviewed per coder during a specified timeframe, typically on an annual basis.
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.
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.
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.
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.
Beyond the Affordable Care Act, regulatory changes and legislative acts will reduce hospital payments by over $218 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed.
Professional and facility coding represent different aspects of a healthcare visit. Hence, the longstanding tradition has been that many hospitals and health systems tend to keep the departments separate. For a growing West Coast-based health system, keeping a wall up between professional and facility coders meant double the work as the volume of claims increased.
According to the AMA’s Principles of CPT® Coding, ninth edition, as reported in the AMA Wire® newsletter, when it comes to medical coding errors, they fall into the broad categories of “fraud” and “abuse.” The former involves intentional misrepresentation. The latter means “the falsification was an innocent mistake, but nonetheless representative,” An example of abuse could involve coding “for a more complex service than was performed due to a misunderstanding of the coding system.”
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.
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).