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Exceptional Coders | Innovative Technology

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: Risk Adjustment, Medical Coding, Coding Compliance, Medical Coding Audits, HCC Coding

Federal Policies to Decrease Hospital Payments by $218B by 2028 – Are You Prepared?

Posted by David Fong on Sep 29, 2018 7:00:00 AM

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.


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Topics: Medical Coding, Outsourcing, Medical Coding Audits

Maximize Coding Productivity By Bringing Professional and Facility Coding Together

Posted by David Fong on Sep 14, 2018 9:00:00 AM
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.
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Topics: Medical Coding, Outsourcing, Medical Coding Audits

Prevent Medical Coding Fraud and Abuse Claims Before They Happen

Posted by David Fong on Aug 30, 2018 5:30:00 AM

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.”


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Topics: Medical Coding, Outsourcing, Medical Coding Audits

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, Outsourcing, Coding Compliance, Medical Coding Audits

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 Coding Audits, Health Information Management, Medical Coders

Stop Challenges Before They Happen with a Comprehensive Accuracy Review of Coding-Related Practices

Posted by David Fong on Jan 24, 2018 10:30:00 AM

A recent Becker’s Hospital Review article stated that Catholic Health had agreed to pay $6M to settle overbilling allegations. A nursing home subsidiary of the health system allegedly submitted claims to Medicare for the highest and most expensive levels of therapy when that type of therapy was not medically necessary or was unsupported by medical records. The allegations against Catholic Health were originally brought by a whistle-blower under the qui tam provision of the False Claims Act.

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Topics: HIM, Medical Coding Audits, Coding Compliance, Clinical Documentation

Revenue Cycle Management Expected to Grow 11% Annually

Posted by David Fong on Jan 11, 2018 7:00:00 AM

The medical sector has been undergoing a series of interminable changes over the last few years. In consequence, healthcare revenue cycle management (RCM) market is set to witness a marked growth because of the rising need for timely bill reimbursements and insurance claims. Increased complexity in the medical coding process has led to the necessity of RCM solutions that help reduce billing errors.

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Topics: Medical Coding, HIM, Medical Coding Audits, Denial Management, Coding Compliance, Clinical Documentation

Hospitals are Reprioritizing Revenue Cycle Management Upgrades Above Other Initiatives

Posted by David Fong on Dec 27, 2017 8:00:00 AM

Almost three-quarters of struggling hospitals are re-prioritizing revenue cycle management over a number of other initiatives. A recent Black Book Market Research survey uncovered that hospitals leaders are pushing revenue cycle management to the top of their priority lists in this last quarter of 2017. The Black Book Research indicated that 74 percent of struggling hospitals are putting population health, analytics, physician practice acquisitions and recruitment, and patient engagement on the back burner to reprioritize revenue cycle management through Q4 2017.

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Topics: Medical Coding, HIM, Medical Coding Audits, Denial Management

Coding Contest Finding 41% Outpatient Coder Accuracy Demonstrates the Need for Improvement

Posted by David Fong on Dec 12, 2017 6:00:00 AM

A recent nationwide ICD-10 coding accuracy and productivity contest by Central Learning demonstrates the fact that the medical coding industry still needs to greatly improve in order to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level. Although there was a slight improvement in inpatient and emergency department accuracy, the ambulatory surgery accuracy score decreased. The average inpatient coder accuracy was 61 percent and the average outpatient coder accuracy was 41 percent.

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Topics: Medical Coding, HIM, Medical Coding Audits