Medical Coding Audits
Coding audit data can be extremely beneficial to the success of a healthcare organization – however, oftentimes, the vast amounts of data being collected can suffocate the organization, especially those that don’t know how to cultivate value and act on the insights received from the audit process.
The Refresh With YES ICD-10-PCS Cardiac Procedures: Heart Assist Devices Learning Path teaches learners how to correctly assign codes for complex cardiac procedures, such as heart assist devices, divided into 13-19-minute webinars. This learning path dives into the different ventricular assist device types, including short-term external and implantable devices. The root operations of “Insertion,” “Removal,” and “Revision” will also be discussed. Learners will review ICD-10-PCS Guidelines, coding examples, and Coding Clinic resources.
Growing a ProFee coding department’s accuracy and quality can be a daunting task – especially if the healthcare organization doesn’t know where to start. Our team of accomplished HIM and medical coding experts has 20+ years’ experience in the industry and is ready to develop a ProFee Coding Quality Improvement Plan specifically tailored to each organization’s goals. Facilities or healthcare organizations that need help developing their ProFee coders should contact us today.
Cross-training your organization’s most qualified outpatient coders in inpatient coding is a sure way to bolster your bottom line and receive the most return on your investment in coding education. But, how do you identify these coders who are ready to train as inpatient coders and grow their professional experience? The key is to rely on a highly skilled team with experience in inpatient coding education, as well as inpatient coding support and auditing services, like YES HIM Consulting. Let our team of experienced HIM and coding experts come in and assist you in implementing this profitable business strategy!
Coding Audits: How Identifying Issues Sooner Rather than Later Saves Money for the Hospital/Facility
The establishment of a coding compliance program remains a significant effort by the Office of the Inspector General (OIG) in its attempt to engage the healthcare community in combating fraud and abuse. The OIG developed a Compliance Resource Portal with materials and guidelines for healthcare professionals. A fundamental element to an effective compliance program is conducting internal monitoring and auditing. Coding audits have the added value of ensuring you are running an efficient and profitable, not to mention minimized liability, operation. Earlier detection of any potential coding issues will pay off financially and will reduce risks for additional external audits.
Healthcare facilities and independent practices face unique challenges when merging or being acquired. This case study provides a thorough analysis on the unique challenges a medical facility faces when merging with independent practices, as well as solutions for a successful facility acquisition process.
Physician group acquisition by major health systems remains a common trend in the industry. One survey of over 8,700 physicians indicates that only 31% of physicians surveyed identify as an independent practice owner or partner as of 2018. This is down from 48.5% in 2012, a whopping 35% decrease in independently owned practices in only 6 years (Merritt Hawkins, 2018). In these acquisitions, the question remains: Who will manage the physician group?
An investigation by the Office of Inspector General (OIG) revealed Medicare Advantage insurers might be overstating patients’ diagnoses without the proper documentation to receive larger payments. Based on the 2016 Medicare Advantage encounter data analyzed by the OIG, insurers were able to get an extra $6.7 billion in payments in 2017.
Medical billing denials generate significant cost for providers and hospitals that could be avoided by improving claims data management and optimizing medical coding processes. Optimal quality coding effectively prevents medical claims denials by reducing the potential for manual error and addressing concerns over fast approaching time limits.
These are 5 common myths of outsourcing, and how YES HIM Consulting debunks these concerns with a skilled team of consultants, coders, and auditors.