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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Forging a bright future for YES, Executives Vanessa Youmans, Director, OP/ProFee Coding & Auditing, and Mari Cely, Director, Business Strategy & Marketing, represented YES at the annual LHIMA Convention, March 2-4, in New Orleans, LA. While attending the HIM convention, whose tagline reads, “Honoring the Past, Treasuring the Present, and Shaping the Future,” Vanessa and Mari focused on “shaping the future” of YES by meeting with members of the LHIMA chapter and connecting with potential clients.

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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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With the number of COVID-19 (2019-Novel Coronavirus) cases expected to rise in North America, the Centers for Medicare & Medicaid Services (CMS) has provided information on how to medically code and bill all encounters related to COVID-19 for Medicare beneficiaries (CMS, 2020).

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The World Health Organization (WHO) declared the 2019 Novel Coronavirus (COVID-19) disease outbreak a public health emergency of international concern on January 30, 2020 (CDC, 2020). This outbreak of the respiratory disease caused by the novel (new) coronavirus was first detected in Wuhan City, Hubei Province, China. It has rapidly spread, and, according to the CDC, has been detected in 37 locations internationally, including cases in the United States. As a result of the public health emergency, the document, “Announcement New ICD-10-CM Code 2019 Novel Coronavirus (COVID-19),” was released to provide guidance on coding this virus.

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Selecting the right E/M code can be tricky – and sometimes, costly – business. On the one hand, the coder does not want to choose a diagnosis that’s too high, which could potentially incur audits or claims denials. But, if the coder selects a code that’s too low, there’s a chance of losing revenue for his or her organization. According to Medical Economics, “payers and auditors use a quantitative scoring process that requires specific elements (i.e., history, exam, and medical decision-making [MDM] – or time spent counseling and coordinating care) for each E/M level” (2020).

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Medicare Payment Systems

The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).

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