Healthcare facilities across the nation have or will have to face Medicare audits at some point. Even those healthcare facilities that have done everything correctly and have never had to face an audit till date cannot be certain that it may not happen in the future. An audit could be due to a single payment or a multitude of payments – in either case,
One of the recurring problems facing healthcare facilities is incorrect coding of Evaluation and Management (E/M) Services. The recent CERT (Comprehensive Error Testing) claim review analyzed by WPS Medicare reveals that within the fifteen or more services reviewed in that sample, three E/M CPT codes had been coded incorrectly in at least 44% of the total bills raised.
One of the biggest challenges faced by healthcare practices and crucial to their very survival is medical billing and collections. A healthy revenue cycle is important to sustain the process of making patients healthy. Unfortunately, physicians are trained to manage human health rather than revenue health and this is where the challenges arise.
Most patients and their families find it very difficult to understand their medical billing documents. Currently, there are no established standards for consumer medical billing documents and patients often receive multiple bills for the same episode of care, albeit varying in content and presentation, from different doctors, labs and hospitals. This makes it very difficult for the patient and their families to tally the bills;
Billing patients for outstanding balances after receiving the portion covered by the insurance company is known as balance billing. This can happen if the insurance company gives less than the amount expected or if an episode of care is mistakenly believed to be in-network and hence expected to be covered by the insurance company. Physicians who are not bound by the in-network rate agreements and are thus classified as out-of-network physicians,
All healthcare facilities – irrespective of whether they are a business enterprise or a charitable institution – have to be financially viable in order to continue to provide services. Clinical documentation improvement (CDI) programs have evolved from being an informal part of the process to becoming the backbone of the facilities financial viability.
Improving clinical documentation leads to revenue gains and most healthcare facilities are now exploring this program. The main reason for getting into this program is to improve your reimbursements and that will happen with improved documentation and coding. However, it is important to set specific goals when putting together a Clinical Documentation Improvement (CDI) program for your facility.