Exceptional Coders | Innovative Technology

Almost three-quarters of struggling hospitals are re-prioritizing revenue cycle management over a number of other initiatives. A recent Black Book Market Research survey uncovered that hospitals leaders are pushing revenue cycle management to the top of their priority lists in this last quarter of 2017. The Black Book Research indicated that 74 percent of struggling hospitals are putting population health, analytics, physician practice acquisitions and recruitment, and patient engagement on the back burner to reprioritize revenue cycle management through Q4 2017.

A recent nationwide ICD-10 coding accuracy and productivity contest by Central Learning demonstrates the fact that the medical coding industry still needs to greatly improve in order to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level. Although there was a slight improvement in inpatient and emergency department accuracy, the ambulatory surgery accuracy score decreased. The average inpatient coder accuracy was 61 percent and the average outpatient coder accuracy was 41 percent.

As you are well aware, Congress created Medicare Advantage (MA) as a risk adjustment payment program that pays insurers more for sicker beneficiaries. Payers in MA receive a yearly fee for each enrolled member and monthly risk adjustment payments for each enrolled beneficiary, based partly on the person’s health status. This program can be open to fraud. Medicare Advantage payers received about $160 billion in 2015 for approximately 16 million beneficiaries. HHS estimates that the FY 2015 Medicare Part C gross improper payment estimate is 9.50 percent or $14.12 billion, along with the FY 2015 net improper payment estimate of 4.32 percent or $6.41 billion.

An article in Modern Healthcare magazine reported that physicians who serve low-income patients with complex conditions are more vulnerable to financial losses in value-based payment models. The study that found these providers, many of them safety-net providers, didn't have the technological infrastructure to report the necessary data.