A recent article in ICD10 Monitor reported that a national coding contest held annually found outpatient coding in 2019 had the worse coding accuracy in the past three years. Central Learning has held this coding contest since 2016.
National Coding Contest Indicates Outpatient Coding Quality Challenges
People-Centered RCM to Bend the Healthcare Cost Curve
A recent Becker's Hospital Review article highlighted healthcare's significance in the American economy. In that, healthcare accounts for more than 17 percent of the nation's gross domestic product, employs more people than any other industry in the nation, and venture capital alone invested more than $23 billion in healthcare in 2018. The article points out that despite these massive investment and the efforts of a talented workforce, many of the nation's hospitals and health systems operate on razor-thin operating margins and face the dual challenge of achieving fiscal sustainability while delivering high quality care to patients.
Physician Documentation and Coding Can Have Significant Provider Impact
A recent Forbes article entitled “Physician Documentation And Coding: The Third Rail?” showcased the potential missed opportunities to fully understanding the correlation between physician documentation and coding and their resulting effects. Whereas patients may interpret documentation as a doctor providing an account of your visit in your medical record, providers have a far greater impact with documentation. Documentation and coding can affect revenue, quality of care, and potentially expose providers to legal compliance consequences.
CMS Latest Final Rule Updates Office/Outpatient E/M Coding and Documentation Policies
The Centers for Medicare & Medicaid Services (CMS) issued a final rule earlier this month that includes updates to payment policies and rates for services provided under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020, as well as updates to its E/M coding starting on January 1, 2021.
Healthcare Waste Eclipses U.S. National Defense Budget, Study Finds
The annual U.S. national defense spending budget represents a massive hard-to-imagine number. Now consider the amount of waste in the country’s healthcare system. Likely a large amount, but it must be less than national defense—right? According to a recent article on CBSNews.com titled “Wasted health care spending in the U.S. tops annual defense budget, study finds,” the healthcare waste actually exceeds the FY2019 national defense budget, and is estimated at $760 to $935 billion per year. This is waste on a scale that’s difficult to imagine. It’s about a quarter of the sum total of healthcare spending. The study referenced in the article is from the Journal of the American Medical Association, and details the immense scale of the problem.
Mammography Coding Changes Highlighted During Breast Cancer Awareness Month
October is Breast Cancer Awareness Month. As part of the overall push for mammogram screening and self-checks, there are also calls for practices to ensure they are coding properly for Medicare-provided mammograms. According to a recent AAPC blog post written by Barbara Aubry, RN, AAPC fellow, there are several important ICD-10-CM updates, recently deleted codes, and updates for 2020. These updates began on October 1st for FY 2020.
Medical Groups and Hospitals Support CMS Proposal to Abandon E/M Coding Changes
Major medical groups and hospitals have backed the CMS' decision to abandon a provision of the finalized 2019 Medicare Physician Fee Schedule rule that would have consolidated the number of Evaluation and Management (E/M) payment levels into one payment rate beginning in 2021. The agency initially proposed the E/M coding measure in the belief that it would reduce clinicians' work to get Medicare reimbursement. However, providers worried that lower reimbursement rates would cut into their bottom lines and create a number of unintended consequences that could hurt patients.
Big Changes for Long-Term Care Coding and Billing with New PDPM Rules
Managers of skilled nursing facilities are eagerly anticipating changes that will change the way they code, bill, collect data, and operate. A September 2019 article from McKnight’s Long-Term Care News details the long-awaited changes for long-term care reimbursements through the new Patient-Driven Payment Model (PDPM). The changes, which go into effect October 1, are revisions to the Resident Assessment Instrument (RAI), which is essentially the “rulebook” for Medicare and Medicaid reimbursements.
Managing E/M Modifier and Incident-to Services Coding
Claim denials can be crippling for providers. And they’re especially irksome when they’re caused by avoidable coding errors. Managing E/M coding modifiers and incident-to services properly are two areas that providers can greatly improve in order to avoid denials and obtain maximum revenue.
Check Your E/M Coding to Avoid Costly Recoupments
Medical coding problems arise in part when they result in payers spotting abnormalities in the claims information. This prompts an audit and discovery of overpayments, and the payer then takes steps to get that money returned. The provider suffers because they’ve used that money for payroll or equipment, and now their cash flow is disrupted. Repeated instances of such recoupments can result in significant dollar drain and additional future reimbursement scrutiny.
Topics: Medical Coding