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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 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

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

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, Medical Coding Audits, Outsourcing