Posts Tagged ‘compliance’
Everything You Need to Know About Claims Denials: Causes, Prevention, ANSI Codes & More
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.
Read MoreCoding Compliance Audit Statistics: What to Do With Them?
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…
Read MoreTop HIPAA Violation Risks to Watch for in Work-from-Home Situations
To minimize the threat COVID-19, many healthcare organizations transitioned their medical coders and billers to work remotely from home. While exposure to the virus is minimized greatly, employees face a different type of issue – HIPAA violation risks.
Read MoreCoding 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.
Read MoreKnow Your CDI Data: Statistics and Trends Analysis for Successful CDI Programs
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.
Read MoreCompliance Audits Shed Light on Performance Improvement in Medical Coding
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.
Read MoreCase Study: To Query or Not to Query … The Power of a Data-Driven Query Program
Across healthcare, the majority of hospitals or healthcare systems have incorporated query programs; however in many cases they are driven solely from a compliance perspective. We’ve prepared a case study using data gathered over the past couple of years, in order to reach an undeniable conclusion: it’s not about the why, it’s about the how.
Read More