Coding Compliance
The healthcare industry sees hundreds of facility acquisitions and mergers every year (PwC, 2020). A critical part of mergers and acquisitions is the due diligence process, which provides a complete financial and performance picture of a healthcare organization to ensure it is a sound investment. Every aspect of the facility, including the physicians, coding, property, finances, and more, are reviewed. In addition, M&A due diligence audits highlight potential liabilities and coding quality issues.
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The onboarding process is a critical phase that sets the tone for an employee’s journey within an organization. However, what comes next is equally important: measuring the coding quality and productivity benchmarks of new hires.
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Healthcare organizations need to put the focus back on medical coding compliance and offer their teams effective strategies to get coding inaccuracies and inefficient claims management under control. Here are several coding compliance strategies to try this quarter for your organization’s clinical documentation improvement and bottom line.
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While most providers are hesitant to complete regular medical coding audits, it’s important to remember that they ensure accuracy and efficiency are maintained throughout the patient-provider relationship.
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There are myriad benefits to performing regular medical coding compliance audits. In order to have a successful audit process, coders must feel like their voices are heard. We’ve compiled these strategies to help empower the coding team during the next audit.
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Healthcare organizations must enact steps to manage the revenue cycle process effectively and efficiently. Thankfully, there are revenue cycle management (RCM) systems and coding reimbursement specialists that rely on data analytics to help streamline the process.
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ED claims denials are a common occurrence in medical facility coding and billing when the payers (or insurance providers) deny a claim for reimbursement. This article dives into the most common causes for these denials, how to prevent them with denial management services, and related topics, such as ANSI codes and the definitions of appeal versus rebill.
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Given that severe malnutrition MCCs increase the dollar amount in Medicare reimbursements, overcoding is a potential risk for all healthcare organizations. Review our recent case study findings where we present compliance, standardization, and improvement opportunities to one client hospital.
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Regular healthcare coding audits are necessary to run a compliant, successful healthcare organization. While the reason for the audit may differ, the overall checklist for conducting a successful audit remains relatively the same.
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The OCR performs a HIPAA compliance audit to confirm that covered entities and business associates protect and properly utilize PHI. Here are the factors and scenarios that trigger an audit.
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