Exceptional Coders | Innovative Technology

2020 presented daunting challenges to the healthcare industry, not only in diagnosing and treating COVID-19 patients, but also in transforming a healthcare delivery system to modern needs. There were hyper-growth adoptions in telehealth as more providers and the public embraced technology for patient engagement. Remote workforce, which has been common for companies like Aviacode for years, became the norm for many, who had to learn new processes if they hadn't been doing remote work before. This was true for medical coders and healthcare RCM workers alike.

The Centers for Medicare & Medicaid Services (CMS) announced the 2021 Medicare Physician Fee Schedule Final Rule that implemented evaluation and management (E/M) CPT code revisions effective January 1, 2021. The E/M code changes increased the work relative value units (wRVUs). However, because all fee schedule changes are required by law to be budget neutral, CMS decreased the conversion factor (CF) used in the fee schedule, resulting in lower reimbursement for other services. Additionally, CMS introduced two new codes, which may result in a new coding audit focus. And telehealth resulting in more than 60 services being added were among some of the other changes in the 2,165 page final rule.

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.

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.

Coordinated Health and its founder and CEO entered recently into an agreement with the federal government to settle False Claims Act allegations, according to the Department of Justice. The health system will pay $11.25 million and founder and CEO Emil Dilorio, MD will pay $1.25 million to settle the allegations. In addition to the monetary settlement, the system entered into a corporate integrity agreement with HHS that will require monitoring of its billing practices for five years.

In mid-September, healthcare revenue cycle and information technology executives gathered in Chicago to discuss the evolving nature of the hospital and health system revenue cycle and how they are responding to its challenges, disruptions and priorities according to Becker’s Hospital Review. The conversation was part of Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference.

Beyond the Affordable Care Act, regulatory changes and legislative acts will reduce hospital payments by over $218 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed.

Professional and facility coding represent different aspects of a healthcare visit. Hence, the longstanding tradition has been that many hospitals and health systems tend to keep the departments separate. For a growing West Coast-based health system, keeping a wall up between professional and facility coders meant double the work as the volume of claims increased.

According to the AMA’s Principles of CPT® Coding, ninth edition, as reported in the AMA Wire® newsletter, when it comes to medical coding errors, they fall into the broad categories of “fraud” and “abuse.” The former involves intentional misrepresentation. The latter means “the falsification was an innocent mistake, but nonetheless representative,” An example of abuse could involve coding “for a more complex service than was performed due to a misunderstanding of the coding system.”

The Centers for Medicare and Medicaid Services has released a proposed rule for the Calendar Year 2019 Physician Fee Schedule that purportedly reduces the corresponding burden of paperwork that clinicians face when billing Medicare, in order to enable them to spend more time taking care of patients. The initiative could greatly affect the time involved in using electronic health records and how clinicians interact with systems.