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Exceptional Coders | Innovative Technology

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, Medical Coding Audits, Outsourcing

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, Medical Coding Audits, Outsourcing

CMS Proposed Rule Reduces Evaluation and Management Coding Burden

Posted by David Fong on Aug 15, 2018 6:00:00 AM

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.


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Topics: Medical Coding, Outsourcing

Hospitals Now Allowed to Use Non-Physician Documentation to Support Coding for Social Determinants of Health

Posted by David Fong on Jul 26, 2018 7:00:00 AM

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.


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Topics: Medical Coding, Clinical Documentation, Outsourcing

The FY2019 ICD-10-CM Code Changes Have Been Released – Are YOU Prepared?

Posted by David Fong on Jul 13, 2018 6:00:00 AM

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.


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Topics: Medical Coding, Clinical Documentation, Outsourcing

Outsourced Clinical Documentation Functions Enhance Patient Care and Healthcare Revenue

Posted by David Fong on Jun 21, 2018 7:30:00 AM

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.

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Topics: Medical Coding, Clinical Documentation, Outsourcing

OIG Sample Finds that More than 60% of Therapy Claims Don’t Meet Medicare Requirements

Posted by David Fong on Jun 8, 2018 6:00:00 AM

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.

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Topics: Medical Coding, Outsourcing, Coding Denial Management

Don’t Lose Potential Revenue Due to Staffing Errors

Posted by David Fong on May 24, 2018 6:00:00 AM

A recent article in the Chicago Tribune reported that the Cook County Health and Hospitals System lost an estimated $165 million or more in potential revenue over the past three years due to lax clerical procedures and employee errors.


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Topics: Medical Coding, Outsourcing, Coding Denial Management

The Rising Costs of Healthcare Billing

Posted by David Fong on May 8, 2018 6:00:00 AM

A recent study reported in a Los Angeles Times article found that healthcare in the United States is very expensive. One of the contributing reasons is that managing healthcare bills is really expensive. How expensive? At one large academic medical center, the cost of collecting payments for a single primary care doctor is upward of $99,000 a year.


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Topics: Medical Coding, Clinical Documentation, Outsourcing, Coding Denial Management

Accurate Coding and Documentation Are Critical in Today’s Value-Based Care Environment

Posted by David Fong on Apr 24, 2018 6:00:00 AM

At the American College of Cardiology’s Cardiovascular Summit in February, one presenter's PowerPoint slide showed how much proper documentation and coding could affect a hospital’s quality measures and bottom line.

 

Reported in Cardiovascular News, Linda Gates-Striby used a hypothetical example of a 76-year-old woman with diabetes and heart failure. If clinicians only documented basic information about this patient, her expected cost of care per month would be in the ballpark of $5,000. But by coding more specific designations for the diabetes and heart failure—and noting an interaction between the conditions—the total risk score value would balloon to $13,554 per month.

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Topics: Medical Coding, Clinical Documentation, Outsourcing