Coding Review

It Only Takes One Code

It Only Takes One Code

How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.

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How to Reduce Claims Denials

How to Reduce Claims Denials

The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.

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Are you making a $12.5M mistake?

Are you making a $12.5M mistake?

In December 2018, a Pennsylvania for-profit hospital and health system, and its CEO agreed to pay a total of $12.5 million to settle allegations they submitted false claims to Medicare and other federal health care programs for orthopedic surgeries. The settlement resolves allegations that top executives exploited a loophole – AKA modifier 59 – that allowed them to double bill federal healthcare payers for surgeries and ignored coding consultants who advised them that they were improperly billing.

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Falling Case Mix Have You Confused?

Falling Case Mix Have You Confused?

The ICD-10-CM/PCS code changes – effective October 1, 2018 to September 31, 2019 – could be the culprit. Comparatively speaking, there are far less changes this year than in years past. The release includes: 279 new codes, 51 deleted codes,143 revised codes. But don’t let the smaller amount of changes fool you…

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