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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

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, Coding Compliance, Medical Coding Audits, Outsourcing

Proposed CMS Risk-Adjustment Changes Could Lower Medicare Advantage Revenue

Posted by David Fong on Mar 9, 2018 12:30:00 PM

Modern Healthcare reported in a recent article that health insurer and provider groups were complaining about the CMS' proposal to use more patient encounter data to determine Medicare Advantage plans' risk scores in 2019, saying the data could reduce payments for plans.

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Topics: Medical Coding, HCC Coding, Outsourcing, Risk Adjustment

KLAS Outsourced Coding 2018 Report Shows an Increasingly Competitive Market with 54% of Providers Maintaining or Increasing Their Outsourcing

Posted by David Fong on Feb 28, 2018 6:00:00 AM

The medical coding industry has evolved since the mandate of ICD-10 on October 1, 2015.  There were concerns of increased backlogs, first-pass denials, and hiring challenges.  That wave of concerns has given way to a maturing outsourced coding industry.

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Topics: Medical Coding, HIM, Outsourcing