ProFee Coding Testimonials

In the year 2020, there are not many industries left that haven’t been modernized and streamlined by innovative technology. The healthcare sector itself has seen numerous improvements in recent years, including cutting-edge treatments, less invasive procedures, digital health records, mobile healthcare apps, and more (Medium/Healthcare in America, 2018). Most of these technologies alone have improved the level of care, efficiency, disease control, and access to better treatments (UIC, 2020). How medical coding adapts to new healthcare technology will have a great impact on preventive and corrective healthcare (Healthcare Business & Technology, 2020).

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HCC specificity

As a follow-up to our previous articles on the subject of Risk Adjustment and HCCs, we now review some scenarios of HCC chronic conditions and the importance of specificity in documentation and coding. Accurate and complete documentation of chronic condition diagnoses by clinicians is an essential component of the risk adjustment and the HCC process. It is also imperative that the documentation of a disease/condition be as specific as possible. Specificity can make a difference in the patient’s treatment plans, as well as accurate code assignments, which then leads to appropriate HCC assignment and payment.

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On March 11, the World Health Organization (WHO) issued a declaration of the COVID-19 as a global pandemic. Two days later, the AMA announced the development of a specific code for laboratory testing for the coronavirus, code 87635 (AMA, 2020). The Centers for Medicare and Medicaid Services (CMS) released two new HCPCS codes for coronavirus testing for Medicare claims. The reporting for COVID-19 testing is dependent on the payer, either an HCPCS or CPT code should be used; there should not be more than one COVID-19 testing code on a given claim.

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Artificial intelligence (AI) can help transform patient data into value at an accelerated pace without incurring high costs or eating up limited time and resources (Wolters Kluwer, 2020). The AI algorithms produce insights into treatments, care processes, diagnostics, and patient outcomes (Health IT Analytics, 2018). Natural Language Processing (NLP) tools, one branch of AI, “include applications such as speech recognition, text analysis, translation, and other goals related to language,” according to Future Healthcare Journal (2019).

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Coding

Medical coding is the process of assigning numeric or alphanumeric codes to the diseases, injuries, treatments, and procedures that healthcare providers perform to record each encounter accurately and correctly bill the patient (Healthcare Business & Technology, 2019). Medical coding directly ties into medical billing, which includes “preparing billing claims and submitting them to insurance providers,” as noted in our previous article, “What Is Medical Coding and Billing? How Does It Streamline a Hospital’s Financial Performance?” Ensuring the encounter was coded correctly with the right terminology is essential for correct payment and an accurate patient medical history.

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ProFee Coding

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?

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ICD 10 training

The 10th release of the International Classification of Diseases (ICD-10) is the most recent cutting-edge edition to the system of codes that categorizes every disease or health problem around the globe. The earlier edition was published about four decades ago, and henceforth the release of ICD-10 coding was predicted as a sweeping change in the world of medical coding.

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