Why You Need Internal Coding Audits

Posted by Jared Petersen on Oct 19, 2018 9:53:00 AM

Fraud. Scary word, right? Well it happens a lot, and if you are not careful it might be happening at your practice right now. “Get a free scooter!” You may remember those words uttered on a commercial that ran continuously a few years back. In August of 2014, the Washington Post broke a story on how the government paid billions of dollars for Medicare recipients to get a free motorized wheelchair. The perpetrators of this scam were intentionally defrauding the government by using loopholes to make huge profits on markups for these chairs.

The wheelchair scam example is an outlier, but it is what most people think about when the topic of fraud is brought to the forefront, but that is just one high profile case. There are many instances of unintentional errors that can occur due to lack of understanding of the many regulations and nuances of medical billing. Consider auditing your providers for compliance and finding opportunities for improvement.

Here are 4 reasons why:



1. Billing Mistakes: still the provider's problem

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Topics: medical coding, Medical Coding Compliance, ICD-10, Medical Coding Services, medical audits, HCC Coding

6 Key Best Practices to Avoid a CMS Compliance Audit

Posted by David Blanchard on Sep 27, 2018 8:54:00 AM

Medicare and Medicaid audits are an extremely popular topic. Imagining the possibility of having your practice or hospital audited for its billing practices is a daunting thought. How simple it can be for a practice to overlook a coding change to IDC-10 or suddenly fall behind the latest PHI requirements.

Failure to stay on top of the changing landscape can lead to major financial problems down the road and the need to pay back unallowable funds. Daily we hear of OIG audits that are the results of missing a coding change or improper practice policies that can be catastrophic to the financial well being of a healthcare organization. 

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Topics: medical coding, Medical Coding Compliance, ICD-10, Medical Coding Services, medical audits

2019 Proposed Fee Schedule Changes - Input From Peers

Posted by David Blanchard on Sep 17, 2018 3:35:10 PM

A few weeks ago The AAFP released its initial summary(2 page PDF) of the proposed 2019 Medicare physician fee schedule which, for the first time, also includes recommended changes that would affect CMS' Quality Payment Program in 2019.  Is this good or bad for you? Let me share some quotes from the AAFP website that can be found here: https://www.aafp.org/news/government-medicine/20180724mpfssumm.html

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Topics: medical coding, Medical Coding Compliance, ICD-10, Medical Coding Services, medical audits, payment posting

"SMART" Year End Revenue Cycle Goals

Posted by Ben Castleberry on Aug 3, 2018 10:06:00 AM

2018 is more than halfway over. "Finishing Strong" will start to be a common message through out organizations all over the country. Goals will be set, measured, and some will be met, some will be exceeded and most will fail. What makes a good goal. What goals should you be setting for your revenue cycle and your medical coding? 

2018 is more than halfway over. "Finish Strong" will start to be a common message throughout organizations all over the country. Goals will be set, measured, and some will be met, some will be exceeded...Most will fail. What makes a good goal? What goals should you be setting for your revenue cycle? 

Before we get into specific goals, lets quickly what sets apart the structure of a good goal versus the structure of a poorly set goal. We call them "SMART" Goals. Specific, Measurable, Attainable, Relevant, and Time-Bound. 

Specific - In terms of revenue cycle and medical coding, you should choose the particular metric you want to improve, like coding related denials, Days in AR, or Overall Medical Coding reimbursement revenue. You should also identify the team members working towards the goal, the resources they’ll have, and their plan of action.

Measurable - If you want to gauge your team’s progress, you need to quantify your goals, like achieving an X percentage increase in Denials, AR, or Reimbursement.

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Topics: medical coding, Medical Coding Compliance, ICD-10, Medical Coding Services, medical audits, payment posting

Changes to Medicare Payments

Posted by David Blanchard on Jul 31, 2018 2:01:42 PM

This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2019 to implement changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. The proposed rule also includes requests for information on promoting interoperability and electronic health care information exchange, improving beneficiary access to provider and supplier charge information, and leveraging the authority for the Competitive Acquisition Program (CAP) for Part B drugs and biologicals for a potential CMS Innovation Center model. In addition, we are proposing to modify the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure under the Hospital Inpatient Quality Reporting (IQR) Program by removing the Communication about Pain questions.

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Topics: medical coding, Medical Coding Compliance, ICD-10, Medical Coding Services, medical audits, payment posting

5 Ways to Boost Practice Revenue

Posted by Dave Cowley on Sep 5, 2017 4:38:48 PM

Your medical practice is about healing patients, but it is still a business. To stay afloat, medical practices must rethink their business models. The tech revolution has transformed healthcare. If physicians don’t embrace new technology, they may miss out on untapped revenue. Here are five ways to boost your practice revenue.


1) Streamline Collections

If you have uncollected bills or spend too much pursuing late payments, your collections process needs an overhaul. Create a more focused system to boost your bottom line, and keep more liquid capital in practice accounts. Leveraging mobile tech and making full use of ICD-10 for your medical coding and supplemental medical coding is a good place to start.


2) Outsource Billing

Outsourcing billing may seem like a huge investment, but it can enhance your profit margins. Many doctors report outsourcing their billing process saves overhead costs and the headache of processing claims in-house. It makes good business sense- billing outsourcing firms have to be competitive- so it only stands to reason that doctors would use to improve their revenue cycle.


3) Monetize Checkup Calls

Checkup calls and emails with patients are becoming increasingly more common, and frequently go unbilled. Consider replacing some follow up calls with online video visits. Patients will happily pay for the convenience. Many patients are more enthusiastic about this option than they are about traditional appointments, and it’s a great way to increase the volume of visits.


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Topics: Outsourced Medical Coding, Medical Coding Services, revenue cycle management

Supplement Your Medical Coding

Posted by Dave Cowley on Aug 21, 2017 2:57:52 PM

5 a.m. hits like a semi truck when my alarm goes off. I begrudgingly get out of bed and begin my morning routine. Being "healthier" this year certainly feels a lot more like being "tired." Once I get my gym clothes on, I feel my way down the dark staircase to my kitchen and pull out my pre-workout supplement. 




Once this 3 step process is complete, I instantly feel a boost. My body responds and I know its time to get to work. I take this supplement combined with protein in the mornings to get the fitness results I want. Medical coding like my new years resolution can offer an extremely positive results on your practices financial outlook, or it can be bleak and discouraging. Lets take a look at how to boost your medical coding with supplements.  

Temporary Coding

Temporary medical coding is a great way to help keep things moving when a coder, office manager, biller, etc. is out on leave or vacation. July and December see an extreme uptick in employee vacation days, leaving administrators with a pile of coding work that needs to be done in order for claims to be submitted. Inevitably the large stack gets coded with a lower quality and higher denials as the recently returned personnel doing the coding is trying to play "catch up" in order to get back to his or her normal routine. Playing catch up is never a good thing when it comes to revenue. Temporary coding is a supplemental medical coding practice that can help providers maintain a level of excellence when coders are not able to perform due to leave. 

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Topics: Outsourced Medical Coding, Supplemental Medical Coding, Medical Coding Services

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