Exceptional Coders | Innovative Technology

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.

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.

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.

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.

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.

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.

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.

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.

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 1^st for FY 2020.

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.