Exceptional Coders | Innovative Technology

A recent article in Skilled Nursing News reported that more than 60% of outpatient therapy claims filed over a six-month period didn’t meet Medicare’s requirements — a figure that has a key government watchdog agency concerned.

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.

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.

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.

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.

Aviacode joins American Health Information Association (AHIMA) in celebrating health information professionals during the 29th annual Health Information Professionals (HIP) this week (March 18–24, 2018).

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.

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.

A recent Kaufman Hall survey found that an overwhelming majority of healthcare executives (96 percent) stated that cost transformation is a significant need for their hospital or health system. Yet, over 50 percent of organizations surveyed either do not have a healthcare cost reduction goal or have such a small goal that it will not, in reality, transform their cost structures.

A recent Becker’s Hospital Review article stated that Catholic Health had agreed to pay $6M to settle overbilling allegations. A nursing home subsidiary of the health system allegedly submitted claims to Medicare for the highest and most expensive levels of therapy when that type of therapy was not medically necessary or was unsupported by medical records. The allegations against Catholic Health were originally brought by a whistle-blower under the qui tam provision of the False Claims Act.