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.
Don’t Lose Potential Revenue Due to Staffing Errors
The Rising Costs of Healthcare Billing
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.
Accurate Coding and Documentation Are Critical in Today’s Value-Based Care Environment
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.
Overcoding and Overbilling: Two Problems with an Easy Solution
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.
Proposed CMS Risk-Adjustment Changes Could Lower Medicare Advantage Revenue
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.
KLAS Outsourced Coding 2018 Report Shows an Increasingly Competitive Market with 54% of Providers Maintaining or Increasing Their Outsourcing
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.