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OIG: Rise in Hospital Stays at the Highest Severity Level are Vulnerable to Upcoding

Posted by David Fong on Mar 31, 2021 8:00:00 AM

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report last month that expressed vulnerability concerns in upcoding, coinciding with hospitals increasingly billing for inpatient stays at the highest severity level. The report found that the number of stays at the highest severity level, which is the most expensive one, increased almost 20 percent from FY 2014 through FY 2019, ultimately accounting for nearly half of all Medicare spending on inpatient hospital stays. Further, its findings saw the number of stays billed at each of the other severity levels decreased, while the average length of stay decreased for stays at the highest severity level.

 

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Topics: Medical Coding, Medical Coding Audits

Hospital Revenues Expect to Remain Impacted in 2021 as Improvements in Medical Coding Look to Close the Gap

Posted by David Fong on Feb 26, 2021 10:00:00 AM

2020 presented daunting challenges to the healthcare industry, not only in diagnosing and treating COVID-19 patients, but also in transforming a healthcare delivery system to modern needs. There were hyper-growth adoptions in telehealth as more providers and the public embraced technology for patient engagement. Remote workforce, which has been common for companies like Aviacode for years, became the norm for many, who had to learn new processes if they hadn't been doing remote work before. This was true for medical coders and healthcare RCM workers alike.

 

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Topics: Revenue Cycle Management, Medical Coding, Medical Coding Audits, Outsourcing, COVID-19

CMS Physician Fee Schedule Includes E/M Coding Updates for 2021

Posted by David Fong on Jan 5, 2021 10:00:00 AM

The Centers for Medicare & Medicaid Services (CMS) announced the 2021 Medicare Physician Fee Schedule Final Rule that implemented evaluation and management (E/M) CPT code revisions effective January 1, 2021. The E/M code changes increased the work relative value units (wRVUs). However, because all fee schedule changes are required by law to be budget neutral, CMS decreased the conversion factor (CF) used in the fee schedule, resulting in lower reimbursement for other services. Additionally, CMS introduced two new codes, which may result in a new coding audit focus. And telehealth resulting in more than 60 services being added were among some of the other changes in the 2,165 page final rule.

 

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Topics: ICD-10, Medical Coding, Medical Coding Audits, Outsourcing

Eight Key Steps to Coding Audits

Posted by David Fong on Nov 20, 2020 7:00:00 AM

Coding audits provide insight into the process of coding itself according to ICD10Monitor's article entitled "Coding Audits: A Compliance Necessity". Although coding audits typically include the review and analysis of the medical record documentation and coding, the article also suggests that one should also review coding policies and procedures, as well as coding operational functions.

 

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Topics: ICD-10, Clinical Documentation, Medical Coding Audits, Outsourcing, CDI

Vendor Management Key to Optimizing RCM Outsourcing

Posted by David Fong on Oct 30, 2020 10:00:00 AM

Providers are facing daunting challenges during the pandemic. Not only in keeping staff and patients safe and healthy, but also in keeping practices financially sound. During these times, an increasing number of organizations, especially those with shortages of qualified medical professionals or those with fluctuating patient volume, have seen revenue cycle outsourcing as a solution. Outsourcing can help identify and implement improvements for better revenue capture and collection. A recent RevCycleIntelligence.com article on "Best Practices When Outsourcing Revenue Cycle Management" underscores the opportunities that revenue cycle outsourcing can have during these pressing times.

 

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Topics: Medical Coding, Medical Coding Audits, Outsourcing, COVID-19

Physician Coding Errors Led to Millions in Overpayments For Stroke Patients, Says OIG

Posted by David Fong on Sep 29, 2020 10:00:00 AM

A report from the U.S. Department of Health and Human Services' Office of Inspector General (OIG) earlier this month found improper physician coding of stroke patients who were transferred from traditional Medicare to Medicare Advantage, which led to overpayments of an estimated $14.4 million. The OIG found nearly all of the selected acute stroke diagnosis codes that physicians submitted to CMS under traditional Medicare that CMS later used to make payments to Medicare Advantage organizations didn't comply with federal requirements.

 

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Topics: Medical Coding, Medical Coding Audits, Pro-Fee Coding, Outpatient Coding, COVID-19

Medical Coding Errors for Severe Malnutrition Led to $1B in Overpayments, According to OIG

Posted by David Fong on Jul 31, 2020 10:00:00 AM

The U.S. Department of Health and Human Services Office of the Inspector General (OIG) recommended earlier this month that the U.S. Centers for Medicare & Medicaid Services (CMS) should recoup the portion of nearly $1 billion that was incorrectly paid to hospitals because of medical coding and billing errors involving severe malnutrition diagnosis codes in FYs 2016 and 2017.

 

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Topics: ICD-10, Medical Coding, Clinical Documentation, Medical Coding Audits, Pro-Fee Coding, Facility Coding, Outpatient Coding

Auditing Process More Meaningful than a Random Sample Selection

Posted by David Fong on Mar 29, 2019 1:13:17 PM

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.

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Topics: Clinical Documentation, Medical Coding Audits

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