Top 5 Tips for Combating 2017 Coding Concerns

The calendar may say the ICD-10 transition is long gone, but practices still will likely feel its repercussions in 2017 in terms of payer requests, denials and the new code set’s influence on value-based care. Looking to next year, practices should start being proactive with these coding opportunities now to consider how the following five […]

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Surprise Medical Bills: Why They Occur And What To Do

Imagine going on Amazon, buying an Electronic Spin the Bottle Game for its listed price of $32.92, receiving the product (sparing the arduous effort required to spin the bottle) and then several weeks later receiving an additional bill for $600. As indicated in a recent study, that’s basically what’s happening in heathcare…quite frequently. Not spin-the-bottle, […]

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11 Ways To Save Money on Medical Expenses

My health insurance plan jumped 24 percent this fall and dropped in quality of coverage. I’m not alone. Rising health insurance costs across the nation have many people worried. A recent 50-state poll released by the Partnership to Fight Chronic Disease revealed that 77 percent of consumers have experienced difficulty using their health insurance in […]

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ICD and DSM Coding Compliance Will Be Important In 2020 and Beyond

On October 1, the grace period for allowing providers to submit “less-than specific” codes ran out. If you recall, when ICD-10-CM went live in 2015, the federal government gave providers a transitional year to adjust to the shiny new code set, get educated and hone their skills at making specific diagnoses. All is well, right? […]

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What’s the Key to Better ICD-10 Coding?

Nearly a quarter of all U.S. hospitals now outsource some or all coding functions. Ninety percent of hospitals over 150 beds currently outsourcing their CDI processes reported in Q3 to have realized significant (over $1.5M minimally) in appropriate revenue and proper reimbursements following the implementation of clinical documentation improvement programs in this past year following […]

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Stopping Healthcare Fraud Before It Can Start

In response to a reporter’s question, notorious bank robber Willie Sutton was quoted as saying thieves rob banks “because that’s where the money is”. Today, the money is in a wide variety of areas beyond banks, including the enormous – and growing – healthcare business. As a result, the amount of theft in the healthcare […]

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90% Report Clinical Documentation Improvement Boosted Revenue

Most hospitals gained at least $1.5 million in healthcare revenue after clinical documentation improvement implementation, a Black Book survey found. Nearly 90 percent of hospitals with 150 or more beds and outsourced clinical documentation functions realized at least $1.5 million in appropriate healthcare revenue and claims reimbursement following clinical documentation improvement (CDI) implementation, reported Black […]

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Experts Say ICD-10 Codes Don’t Go Far Enough

When CMS switched from ICD-9 to ICD-10 last year, the new diagnosis classification list allowed coders to translate additional elements of doctors’ language to billers’ language. In a sense, ICD-10 added “adjectives” to coders’ vocabularies: oncology coders now have the ability to describe additional aspects of a tumor, such as whether it resides in the […]

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Meet The New ICD-10 Codes And Prepare For Increased Audits

The ICD-10 codes changed for 2017 and include 1,974,311 deleted codes, and 425 revised codes. These went into effect October 1, 2016. Most chiropractors, fortunately, are only affected by about 70 of these changes—none of which are groundbreaking. But you should be aware of these changes because using deleted codes will result in denied claims. […]

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Information Governance, Informatics Are Top Priorities For AHIMA

As the healthcare industry transitions from fee-for-service to value-based care, health information professionals are on the frontlines of these momentous changes helping clinicians leverage technology to achieve better patient outcomes while reducing costs. The American Health Information Management Association’s mission is to advance data analytics, informatics, and information governance in support of these goals. AHIMA, […]

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Computer Assisted Coding Can’t Replace Competent Coders

Are you familiar with IBM’s supercomputer Watson? IBM’s stated aspiration is to make it “the world’s best diagnostician,” because it can store way more medical information than a human doctor and makes decisions based on evidence, free of cognitive biases. It is consistent, and, according to the company, “given the same inputs, Dr. Watson will […]

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5 Findings From Nationwide ICD-10 Coding Contest

Central Learning’s national 2016 ICD-10 coding contest highlighted the converse relationship between coding accuracy and productivity across inpatient, ambulatory and emergency settings. Central Learning is a web-based coding assessment application, belonging to AVIANCE’s suite of health information and revenue cycle management solutions. More than 550 coders registered with Central Learning to code 1,859 cases in […]

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Computer Assisted Coding: An Auditor’s Findings

The use of computer-assisted coding (also known as CAC) software is becoming more widespread in the coding industry, particularly in the coding of inpatient claims. It’s not a surprising trend, really, given the many known benefits of implementing a CAC system. Computer-assisted coding software helps streamline the coding workflow, reducing backlogs by increasing productivity. Specifically, […]

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Careful Planning Can Reduce Vaccine Associated Losses

Vaccine administration is an important element of primary care practice, and a critical contribution to preventive care public health. But as vaccine and overhead costs continue to rise—particularly for private practices—physicians can have a difficult time aligning expenses with revenues. A decade-old paper published in Vaccine sought to estimate the expense practices face from administering […]

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Transformation with Transplantation

Are you an organ donor? Before October 2005, I did not think much about this question. You may ask what happened in October 2005. My cousin had a heart transplant that month. He had been on the heart transplant list since October 1996. My cousin was 45 years old and suffered a heart attack when […]

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DRG Downgrading: Fight the Good Fight

EDITOR’S NOTE: During a recent Talk Ten Tuesday broadcast, listeners were asked “what percent of your claims are downgraded by third-party payers?” Downgrading by third-party payers occurs when the hospital-billed DRG is changed upon review by health insurance auditors to a lower-paying DRG. The majority of those who responded, over 51 percent, indicated they did […]

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