Medical Coding Audits
Karen Youmans, MPA, RHIA, CCS, President and CEO of YES HIM Consulting, and Vanessa Youmans, MA, RHIA, CCS, CPC, Vice President, Coding Services, co-authored their latest ProFee Case Study in the Journal of AHIMA – October Edition. AS HEALTHCARE ORGANIZATIONS strive for continuous efficiency and sustainability, mergers and acquisitions (M&A)among diverse medical facilities provides organizations new opportunities to reduce costs and generate a larger footprint in both current and new markets…
Manual errors, input omissions, and timing concerns could be instigating more denials than you realize. Keep an eye on these collective reasons for insurance denials to see if you can constrict your billing approach and reduce your rate of denials.
This case study summary provides an analysis on the unique challenges a medical facility faces when merging with independent practices (I.E. the impact on overall medical coding quality, turnover rate, and productivity), and the solutions we have crafted to be implemented for maximum results.
With more and more companies looking beyond their own departments to outsource this task, it’s important to consider the key factors of choosing a coding audit vendor that is just the right fit.
Efficient coding audit practices have become a crucial and necessary step in what healthcare organizations must do to remain compliant and profitable. Now is the time to take the essential step of seeking an independent entity to conduct regular coding audits.
The effectiveness of value-based care models is measured based on how this type of reimbursement can improve the quality of a patient’s overall health. Reducing hospital readmissions and improvement in preventive care are good examples of critical factors to assess the effectiveness of these models. U.S. legislation is clearly moving towards the adoption of value-based care models.
Identifying trends in MS-DRGs is not enough to validate a CDI program. Key CDI data, gathered and analyzed from principal diagnosis (PDX), complications and comorbidities (CC), major complications and comorbidities (MCC), and ICD-10-PCS code assignments, provide deeper insights and assist in an accurate validation of a CDI program and its impact on the bottom line.
Is my team’s coding accuracy up to industry standards? This is a question many HIM and Coding decision makers find themselves asking. Coding compliance audits can provide an organization the ability to follow regulatory guidelines in regards to their coding practices. Get an overview of the impact compliance audits have on both the hospital level and the physician-practice level. Read more.
With the ongoing trend of physician group acquisition, facility-side managers are increasingly assigned the role of also managing the coding policies of newly-acquired physician groups with very little experience in the ProFee arena. So, what makes ProFee coding and billing so different from the facility culture? Find out more here.
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