In the ever-evolving landscape of healthcare, staying ahead of changes while maintaining efficiency and accuracy can be a challenging task. However, there is a rising solution offering multiple benefits including increased reimbursements, improved compliance, and reduced burden on in-house staff – outsourcing medical coding services. Dive into this article to discover how your healthcare facility can unlock the numerous advantages of professional medical coding services without the need for additional training or increased overheads. Professional medical coding services can bring several advan ..read more

In an era where healthcare systems are intricately tied to digital platforms, meticulous coding accuracy cannot be a mere afterthought; it is an absolute necessity. Often overlooked, coding errors are the silent killers of compliance in the healthcare sector. This post delves into the ins and outs of auditing coding compliance. We aim to guide you through potential pitfalls, help uncover deficiencies, and most importantly, offer actionable solutions to fortify you against preventable regulatory nightmares. Buckle up as we embark on a journey of transforming complexities into clarity. Coding au ..read more

Amid the complex labyrinth of healthcare administration, one area stands as a beacon of efficiency and cost-effectiveness—outsourcing medical coding. It brings an exhaustive list of benefits ranging from unburdening clinicians, reducing compliance exposure, minimizing claim denials, and optimizing revenue capture.  This post dives into the compelling reasons why outsourcing medical coding can improve operations, maximize accuracy, ensure compliance, and drive growth. Outsourcing medical coding is a strategic move that offers numerous advantages to healthcare providers. By partnering with ..read more

Navigating the complex labyrinth of HCC coding is a daunting task for healthcare providers, and non-compliance could mean substantial revenue loss and hefty fines. In an era where healthcare services are under financial pressure like never before, unsurpassed accuracy in HCC coding has become an operational necessity. In this blog post, we will guide you through effective strategies to maintain compliance, minimize risk exposure, and safeguard your revenue in the volatile landscape of HCC coding. Hold on tight as we dive into the realm of Hierarchical Condition Categories and their profound im ..read more

Why Conduct a Medical Coding Audit Medical coding audits ensure accurate clinical documentation, improve revenue cycle management, and maintain compliance with industry regulations. Improved Accuracy of Clinical Documentation Accurate clinical documentation supports the quality of care delivered to the patients and the providers’ medical coding, which translates diagnoses and procedures into standardized codes used for billing purposes.  Audits by coders skilled in a specific medical specialty can identify discrepancies and deficiencies in medical records. Improving Revenue Cycle Manageme ..read more

https://www.beckershospitalreview.com/legal-regulatory-issues/indiana-system-to-pay-2-9m-to-settle-medicaid-overbilling-allegations.html Fort Wayne, Ind.-based Parkview Health System has agreed to pay $2.9 million to settle allegations it overbilled Medicaid between January 2017 and March 2021. Improper revenue codes were submitted to Medicaid for certain blood-clotting tests performed on patients at several Parkview hospitals, according to a Sept. 27 news release from the Indiana Attorney General’s Office. Attorney General Todd Rokita said Parkview cooperated with the office when th ..read more

Kaiser Permanente and members of its healthcare consortium defrauded Medicare of nearly $1 billion by tacking on diagnoses to patients’ medical records to earn more in reimbursement payments, the Department of Justice claims in a complaint filed Monday. The DOJ alleges Kaiser looked through Medicare Advantage medical files and pushed physicians to retrospectively add new diagnoses that didn’t exist or were unrelated to patient visits, Bloomberg Law first reported. “The driver was money: so that Kaiser could submit these improper diagnoses to CMS for payment,” the complaint reads ..read more

CMS selects primary care payment model participants According to Becker’s Hospital Review, “CMS chose 916 primary care practices and 37 regional health plan partners as participants in its new payment model called Primary Care First. PCF was designed to decrease the amount of avoidable hospital visits and total cost of care through performance-based adjustments. The practices CMS selected as participants generally include primary care clinicians who serve seriously ill populations in high need of care. Participants will start using the alternative payment model Jan. 1, 2021, and CMS plans to t ..read more

OIG Tags Arizona Hospital for Erroneous Billing Flagstaff (Ariz.) Medical Center failed to comply with Medicare billing requirements for three of 100 inpatient and outpatient claims reviewed by HHS’ Office of Inspector General, according to an OIG report. The three claims that did not comply with Medicare billing requirements resulted in Flagstaff Medical Center receiving $79,216 in overpayments during the two-year audit period of January 2016 through December 2017, according to the OIG. The post OIG Tags Arizona Hospital for Erroneous Billing appeared first on The Coding Network ..read more

Neurosurgeon Medical Practice Director to Pay Over $1 Million Neurosurgeon Medical Practice Director to Pay Over $1 Million to Resolve False Claims Act Liability Arising from Billing of P-Stim Devices. PHILADELPHIA – First Assistant United States Attorney Jennifer Arbittier Williams announced that neurosurgeon Sagi M. Kuznits, practice director Pnina Kuznits, and Neurosurgical Care LLC (collectively, “Kuznits”), have agreed to pay $1,017,375.03 to resolve liability under the False Claims Act for the alleged improper billing of electro-acupuncture devices called Stivax and/or P-Stim and a memor ..read more