Coordinated Health and its founder and CEO entered recently into an agreement with the federal government to settle False Claims Act allegations, according to the Department of Justice. The health system will pay $11.25 million and founder and CEO Emil Dilorio, MD will pay $1.25 million to settle the allegations. In addition to the monetary settlement, the system entered into a corporate integrity agreement with HHS that will require monitoring of its billing practices for five years.
In mid-September, healthcare revenue cycle and information technology executives gathered in Chicago to discuss the evolving nature of the hospital and health system revenue cycle and how they are responding to its challenges, disruptions and priorities according to Becker’s Hospital Review. The conversation was part of Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference.
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.”
The Centers for Medicare and Medicaid Services has released a proposed rule for the Calendar Year 2019 Physician Fee Schedule that purportedly reduces the corresponding burden of paperwork that clinicians face when billing Medicare, in order to enable them to spend more time taking care of patients. The initiative could greatly affect the time involved in using electronic health records and how clinicians interact with systems.
A recent Becker’ Hospital CFO Report article noted the changing of the rules governing reporting of social determinants of health following the American Hospital Association's diligent work. The association said the ICD-10-CM Cooperating Parties, including AHIMA, AHA, CMS and the National Center for Health Statistics, approved advice published by the AHA Coding Clinic that allows hospitals to report ICD-10-CM codes included in categories Z55-Z65, based on documentation from all involved caregivers, including non-physicians. That change took effect in February of this year.
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.
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.
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.