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Eight Key Steps to Coding Audits

Posted by David Fong on Nov 20, 2020 7:00:00 AM

Coding audits provide insight into the process of coding itself according to ICD10Monitor's article entitled "Coding Audits: A Compliance Necessity". Although coding audits typically include the review and analysis of the medical record documentation and coding, the article also suggests that one should also review coding policies and procedures, as well as coding operational functions.

 

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Topics: ICD-10, Clinical Documentation, Medical Coding Audits, Outsourcing, CDI

Vendor Management Key to Optimizing RCM Outsourcing

Posted by David Fong on Oct 30, 2020 10:00:00 AM

Providers are facing daunting challenges during the pandemic. Not only in keeping staff and patients safe and healthy, but also in keeping practices financially sound. During these times, an increasing number of organizations, especially those with shortages of qualified medical professionals or those with fluctuating patient volume, have seen revenue cycle outsourcing as a solution. Outsourcing can help identify and implement improvements for better revenue capture and collection. A recent RevCycleIntelligence.com article on "Best Practices When Outsourcing Revenue Cycle Management" underscores the opportunities that revenue cycle outsourcing can have during these pressing times.

 

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Topics: Medical Coding, Medical Coding Audits, Outsourcing, COVID-19

Physician Coding Errors Led to Millions in Overpayments For Stroke Patients, Says OIG

Posted by David Fong on Sep 29, 2020 10:00:00 AM

A report from the U.S. Department of Health and Human Services' Office of Inspector General (OIG) earlier this month found improper physician coding of stroke patients who were transferred from traditional Medicare to Medicare Advantage, which led to overpayments of an estimated $14.4 million. The OIG found nearly all of the selected acute stroke diagnosis codes that physicians submitted to CMS under traditional Medicare that CMS later used to make payments to Medicare Advantage organizations didn't comply with federal requirements.

 

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Topics: Medical Coding, Medical Coding Audits, Pro-Fee Coding, Outpatient Coding, COVID-19

Hospital Financial Performances Starting to Recover As Providers Increasingly Consider Outsourcing

Posted by David Fong on Aug 31, 2020 7:45:00 AM

While hospital financial performance is starting to recover after experiencing historic lows at the start of the COVID-19 pandemic, providers still face a bumpy road ahead, according to experts at Kaufman Hall. Comparing July 2020 to June 2020, hospital operating margins increased 24 percent. Operating EBITDA margins also increased by 12 percent month-over-month and were 9 percent above budget without the financial aid despite falling by 5 percent year-over-year, the firm reported.

 

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Topics: Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19

Medical Coding Errors for Severe Malnutrition Led to $1B in Overpayments, According to OIG

Posted by David Fong on Jul 31, 2020 10:00:00 AM

The U.S. Department of Health and Human Services Office of the Inspector General (OIG) recommended earlier this month that the U.S. Centers for Medicare & Medicaid Services (CMS) should recoup the portion of nearly $1 billion that was incorrectly paid to hospitals because of medical coding and billing errors involving severe malnutrition diagnosis codes in FYs 2016 and 2017.

 

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Topics: ICD-10, Medical Coding, Clinical Documentation, Medical Coding Audits, Pro-Fee Coding, Facility Coding, Outpatient Coding

Appeals Court Nixes Fraud Case, Affirms Health System's Coding & CDI Practices

Posted by David Fong on Jun 23, 2020 8:00:00 AM

Last month, the United States Court of Appeals for the Fifth Circuit affirmed a lower district court decision to dismiss a False Claims Act lawsuit brought against a Texas-based hospital system. The lawsuit by a data analytics firm accused the health system of fraudulently using secondary diagnosis codes to increase its revenues over a six year period.

 

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Topics: ICD-10, Medical Coding, HCC Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding

Medicare Payment Rates Announced for COVID-19 Test CPT Codes

Posted by David Fong on May 22, 2020 9:30:00 AM

More than 10 million COVID-19 laboratory tests have been conducted in the United States thus far. While the US testing per capita rate still lags behind several other countries, the number of tests completed continues to rise. These tests are medical coded and reimbursed just like other medical procedures. The CPT codes announced in March and April when testing became prevalent in the United States now have associated Medicare MAC payment rates.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19

Telehealth Usage Skyrocketing During This Pandemic

Posted by David Fong on Apr 23, 2020 9:30:00 AM

Telehealth usage is skyrocketing during this COVID-19 pandemic, as the way people interact with each other and their healthcare providers change. The increased demand in remote video technology, or in its absence telephony, for clinical interactions has led to changes in how providers offer patient care, as well as led to changes in reimbursement policies enacted and enforced by the federal government.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19

Medical Coding COVID-19 Challenges and Answers

Posted by David Fong on Mar 25, 2020 8:00:00 AM

The medical coding industry before COVID-19 made it easy for you. If you were outsourcing it was simply domestic versus global. Fast forward to this COVID-19 pandemic, the healthcare industry has been flipped on its head. Hospitals are expecting a surge in demand with an increasing number of testing, triage and positive COVID-19 patients needing hospitalization. This in the face of a short supply of hospital beds, ICUs, and ventilators, as well as temporary facilities being added as fast as possible. Medical coding is facing similar challenges to meet this growing demand.

 

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding

National Coding Contest Indicates Outpatient Coding Quality Challenges

Posted by David Fong on Feb 13, 2020 5:15:00 PM

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.

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Topics: ICD-10, Medical Coding, Pro-Fee Coding, Outpatient Coding