Medical Coding Audits
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.
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.
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.
Medical necessity denials can’t be ignored, as they can lead to significant revenue loss and compliance issues. These best practices for clinical documentation improvement, education, and standardization will help providers overcome their medical necessity denials.
Anticipating coding quality strengths and weaknesses is a great benefit trending reports offer when it comes to coding compliance audits. A coding team can remain accurate and competitive by taking advantage of the benefits trending analysis has to offer.
To successfully navigate the future – and be prepared for anything – healthcare organizations need to craft a strategic plan. A strategic plan is beneficial for everyone: It allows the company owner to identify potentially fruitful goals, and it helps the employees foster that growth.
Year by year, organizations rely more and more on their data analytics. In this article you will be provided with: An overview of key statistics to include in your coding compliance audits, a Questionnaire to determine if you need a coding compliance audit program…
Outdated and ineffective revenue cycle processes cost healthcare providers billions of dollars annually. It’s time to review your revenue cycle processes and employ management vendors to get your bottom line back on track.
Does your organization struggle to efficiently interpret and utilize data presented in the PEPPER Reports? Then, read below for an in-depth review of the PEPPER metrics and how we help our clients capitalize on the data.
Every year, the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA) release updated coding and reporting guidelines that make additions, deletions, and revisions to the ICD-10 and HCPCS code sets, and CPT codes, respectively. During Public Health Emergencies (PHE), such as the COVID-19 pandemic, CMS and AMA will release updates more frequently. By offering ongoing medical coding training to cover these annual updates, your coding team upholds an accuracy standard and stays compliant with these revised guidelines. YES Education offers a robust catalog of medical coding updates that refreshes as the code set revisions are released, including annual updates for ICD-10-CM/PCS and CPT.