Medical Billing Blog: Section - Medical Coding
Archive of all Articles in the Medical Coding Section
This is the archive containing links to all articles written in the Medical Coding section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
MIPS: The Day of Reckoning
One of my favorite books is The Big Short by Michael Lewis. It was eventually made into a movie by the same name and gives a clear view of the housing bubble that burst 10 years ago and pushed the US economy into the Great Recession. What fascinates me was the ability of some to predict, and profit, from knowing when the collapse would occur. They were able to delve into the details of millions of mortgages and see when the adjustable rates would suddenly increase leading to escalating mortgage payments and boosting the default rates dramatically. The subsequent collapse was unavoidable, and predictable. What does this have to do …
Newly-Designed EHR Notes May Improve Usability
Showing less data in physician EHR notes may produce more benefits for physician productivity, according to a recent study published in the Journal of the American Board of Family Medicine (JABFM). The study by Jeffery Beldon, MD et al. compared different physician EHR note designs to see which design physicians found most efficient, accurate, and usable when attempting to obtain information for ambulatory chronic disease care. Researchers devised four physician note designs and tested the designs on 16 primary care physicians in random order. Physicians were instructed to find key information in the EHR notes during timed tasks. Physicians then gave each note design a usability rating and new feature …
7 strategies to prevent claims denials
Claims denials pose a serious issue for hospitals amid an already complicated reimbursement landscape. “Denials are a huge obstacle to timely and complete reimbursement,” said Carmen Sessoms, associate vice president of the revenue cycle management advisory services program at Nashville, Tenn.-based Change Healthcare. In 2016, Change Healthcare managed 1.8 billion transactions with a value of more than $3 trillion. Leveraging this data, analysts determined approximately 9 percent of claims with a value of $262 billion were denied. These denials impacted about 3.3 percent of net patient revenue, translating to an average of $4.9 million per hospital. Denials are not only highly prevalent in the healthcare environment, but also very costly …
Hypertension Coding in the Age of Quality
The hypertension “epidemic” hearkens back to boxer Joe Louis’ words regarding a smaller, quicker opponent — light heavyweight Billy Conn, “You can run, but you can’t hide!” No matter what specialty of medicine or surgery you practice, or whether you are a primary-care provider, elevated blood pressure represents a recurring problem that will not go away. Furthermore, hypertension is often accompanied by comorbid conditions such as diabetes mellitus, obesity, CKD-3, and systolic dysfunction which complicates blood pressure treatment, according to researchers at University of Miami Miller School of Medicine. The downside of this epidemic is clear, untreated blood pressure is fraught with multiple target organ complications. In fact, approximately 80 …
Most Providers Report Lack of Health IT Interoperability
A new eHealth Initiative survey found 68 percent of providers believe current interoperability solutions fail to help meet the goals of value-based care. Researchers in 2017 Survey on Access to Patient Information gathered responses from 107 respondents including CEOs and other executive leadership, IT leadership, clinical staff, and administrative leadership from hospitals, health systems, medical groups, physician practices, HIEs, and other organizations. The survey addressed issues including health data exchange, interoperability, federal regulations, patient access to information, and patient engagement. Researchers found that most providers believe technology has improved healthcare quality since 2008, but certain areas—including interoperability—are still in need of significant improvements. “Sixty-three percent agree that technology has helped …
10 Common Physician RCM Mistakes
If you’re familiar with the beloved sitcom “Seinfeld,” then you have probably seen “The Opposite,” an episode where George Costanza takes it upon himself to do the complete opposite of what he believes is right. The episode serves as the inspiration for Craig Pedersons’ presentation, “Physician Compensation: 10 Common Mistakes (and Four Solutions),” at the Medical Group Management Association (MGMA) Annual Conference in Anaheim, Calif. “I am going to go through case studies and specific examples of financial train wrecks. I’m not trying to tell people what to do, I’m telling them what to avoid. Case studies allow examples to become a lot more real,” says Pederson, a principle consultant …
The Cloud Protects Practices from Mother Nature
Late last week, as Irma devastated Florida’s Atlantic and Gulf coasts, I had the opportunity to speak with one of our medical practices in the area. As I shared my concerns and best wishes with them, they quickly reminded me how valuable it is to have their entire practice’s data securely stored in the cloud—far away from the rain, devastating winds, and storm surge. With the destruction left in the wake of hurricanes Irma and Harvey, it is wonderful to know that cloud technology is helping people worry less and avoid further damage. Here are four disasters modern medical practices across the southern U.S. will sidestep in the storm aftermath: …
Is Your EMR User Friendly?
A common complaint about EMRs is that while they might have technical capability, they might not have real world usability, or be “user friendly”. Thus, you might be able to enter A, B and C; but finding the previous values of A, B and C might be challenging, and seeing the history of A, B and C might not be possible. As I sat in front of one of my medical providers recently, who is a late and reluctant convert to EMRs, he created an on paper list of my previous values as he inefficiently hunted through my now online history. And unless he types them back in in a …
EHR companies refuted claims of violating HIPAA
The EHR Association (EHRA) Executive Committee has fired back at accusations that EHR companies are partially to blame for interoperability problems, claiming health data exchange is progressing quickly. The association published a response to an earlier post on Health Affairs Blog that accused EHR and health IT companies of monetizing the custody of patient protected health information (PHI). Former ONC Chief Privacy Officer Lucia Savage urged the Office of Inspector General (OIG) to enforce provisions of HIPAA prohibiting business associates such as EHR developers from using PHI for business operations. She stated some EHR companies may be leveraging ownership of patient PHI for profit. “Building a revenue stream out of …
How to Choose Between Modifiers 25 and 57
When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service,” or modifier 57, “Decision for surgery” to the E&M service code. Modifier Identifies Separate Nature of E&M Service A minimal patient evaluation is necessary to determine that a prescribed treatment is appropriate to manage the patient’s condition. For example, if a patient presents for a previously scheduled injection, the provider will briefly evaluate the patient to confirm that the injection remains …
