$68 Billion in Medical Billing Errors Puts Physicians’ Livelihood in Jeopardy

As many as 80 percent of all medical claims submitted to insurance carriers contain mistakes estimated at $68 billion (1). Approximately 55 percent of evaluation and management (E/M) claims are incorrectly coded resulting in $6.7 billion in improper Medicare payments.(2) Providers looking to avoid lost revenue and serious consequences are raising the training standards of its administrative staff seeking out those who have completed specialized training and certification offered by Practice Management Institute (PMI).

Watchdog agencies, enforcement, and penalties are on the rise, creating a high-risk environment for physicians. Tighter screening measures adopted by the Affordable Healthcare Act have resulted in 17,000 providers losing their license to bill Medicare (3). Doctors have ultimate responsibility for all claims billed under their unique provider number, and a physician’s signature on any claim is held as verification of the accuracy and legitimacy of each claim (4).

Increased scrutiny has prompted doctors and healthcare facilities to require their employees to become certified. From an enforcement perspective, staff who knowingly submit fraudulent claims for payment can be held liable (5).

David Womack, President and CEO of PMI, says, “It’s critically important that providers have well trained staff. The physician needs to have confidence that their personnel are running the business correctly so they can focus on quality patient care.”

Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration.

Womack says, “Taking steps to successfully train and certify staff in these areas means physicians are more likely to submit accurate claims and receive correct payments for their services, and ensure that practice liability is minimized.”

About Practice Management Institute (PMI):

For more than 30 years, Practice Management Institute, also known as PMI, has helped physicians, hospital systems, medical societies, and educational institutions provide comprehensive education and training to medical office staff nationwide. By offering a variety of educational programs and professional certifications, PMI helps to build competency, compliancy, and effectiveness that assures the continued success of their clients.

Since PMI’s formation in 1983, more than 20,000 individuals have earned certification in one more areas of expertise. PMI is recognized by both the Centers for Medicare and Medicaid Services and the Department of Labor for training in: medical coding, third-party billing, office management, and compliance. PMI training helps ease the burden of running a successful medical practice through thorough education and up-to-date training for non-clinical staff, allowing physicians to focus on patient care to improve the experience of the patient. For more information, visit http://www.pmiMD.com.

About David Womack:

David Womack, President and CEO, has been instrumental in PMI’s continued success since 1991. He has helped PMI transition into a cutting-edge leader in medical office staff education and training while developing key relationships with healthcare organizations, hospitals, colleges, and medical societies across the country. His commitment to excellence has helped PMI become an industry leader recognized by both governmental organizations and healthcare systems across the country.


1.    “Incorrect Medical Coding Corrupts the Core Data Used by Health Care Facilities, Has Negative Consequences Throughout Health Care Industry.” Integrated Healthcare Executive. N.p., n.d. Web. 05 May 2017.
2.     “55% of E/M Claims Incorrectly Coded – What’s Your EMR Software Doing to Help?” HealthFusion, June 24, 2014.
3.    The $272 Billion Swindle.” The Economist. The Economist Newspaper, 31 May 2014. Web. 05 May 2017.
4.    College, From The. “Who Is Liable for Coding Mistakes?” The Rheumatologist. N.p., 01 Oct. 2010. Web. 05 May 2017.
5.    U.S. Department of Justice Memo, “Individual Accountability for Corporate Wrongdoing” aka, the Sally Yates Memo, September 9, 2015.

Continue reading “$68 Billion in Medical Billing Errors Puts Physicians’ Livelihood in Jeopardy”

5 Best Practices To Ensure A Smooth, Expedient ICD-10 Transition

The ICD-10 Compliance date is looming and it is imperative that healthcare providers be prepared to make the transition. It affects everything from claims processing, physicians’ workflow, and patients’ access to care. Many organizations may be rallying employees and resources in order to make the switch from the ICD-9 to the ICD-10 coding for medical diagnoses and inpatient hospital procedures before the implementation date of October 1, 2015.

To make matters worse, the transition is not easy, but a major undertaking with nearly 19 times as many procedure codes and almost five times as many diagnosis codes in the ICD-10 than in the ICD-9. While the ICD-10 switch is definitely necessary, as the outdated and clinically inaccurate ICD-9 has not been updated since its installation, in 1979, the ICD-10 stands to enhance the quality of healthcare, improve data for epidemiological research, as well as enable physicians to make better clinical decisions. However, this is dependent on the ability for the healthcare industry to make a smooth and accurate transition to the new International Classification of Diseases, according to Richard Milam, president and CEO of EnableSoft

In order for healthcare providers to successfully meet the ICD-10 deadline, Milam suggest five best practices to ensure an expedient, smooth ICD-10 transition:

Richard Milam, president and CEO of EnableSoft
1. Employ Robotic Process Automation That Does the Work for You

“You” is meant to imply the entire organization because that is how many resources it will take to have the ICD-10 switch completed by the deadline if Robotic Process Automation is not used to update and add the multiple new codes into EMR, NDC, medical billing, and claims processing data systems. Certain softwares may have to upgraded or replaced to support the 68,000 diagnoses codes and nearly 87,000 procedure codes; however, through a series of human-directed scripts, Robotic Process Automation technologies will populate the specific fields in the data systems with the ICD-10 data required. The already costly transition to the new ICD-10 can be mitigated by not having to outsource or hire new employees to enter the new codes manually. Furthermore, the data transition can take place over the course of a few days, not a few months, ensuring healthcare providers will be ready to transition to using the new ICD-10 codes.

2. Test Your Software

Not only should you confirm with your clearinghouses, billing service, and payers that they will be upgraded and compliant with the ICD-10, but when they will be ready for testing to occur. Robust end-to-end testing must occur with your software in order to ensure claims are being accepted properly and processed by insurance contractors, Medicaid, Medicare, and other payment processes are operational. Test internally to ensure transactions can be generated and sent with the ICD-10 codes and test externally to ensure the transactions are successfully received by payment providers and that the payment can be processed correctly. After October 1, any ICD-9 codes used in transactions will not be accepted for services and will be rejected for payment. Failure to test your software properly can result in disruptions in patients’ receiving the treatment they need and receipt of due payments.

3. Educate or It All Falls Down

The updated, enhanced medical coding that is to enhance and improve patient diagnoses, performed procedures, treatment, and billing will not prove capable of these abilities without humans to employ its codes, terminology, and procedures appropriately and correctly. You must educate your staff about the changes to the ICD-10 and perform practices and routines in order to prepare for the change. Have each of your staff participate in educational seminars in order to become informed of the changes and how that will affect their position, the procedures patients are to undergo based on the new diagnosis codes, as well as the improved treatments that patients are to have performed. Assist and inform staff by identifying the 50-100 most commonly used ICD-9-CM diagnosis codes based on specialties and determine the equivalent ICD-10-CM codes, and have this information accessible before and after the implementation of the ICD-10. Having your staff prepared and knowledgeable about the ICD-10 will reduce delays in patient care and procedures, which is the reason for the ICD-10—to deliver improved diagnosis and advanced medical treatments that will enhance patients’ quality of care.

4. Implement an Effective Communication Method and Coordinate Conflict Resolution

While making the data transition and update to the new and diverse medical coding that is in the ICD-10, it is imminent that there may be delays in processes, confusion over coding and form completion, as well as workflow changes. Make sure your employees know who they can contact or call on if they are unsure of what code to report, how to complete a form, or other transitory questions that may arise following the implementation of the ICD-10. Identify leads and supervisors for each workflow and specialty area that will be available for their staff requests and questions, and make sure those individuals are highly educated on the ICD-10 and have the authority to execute a resolution. Additionally, determine how transactions handled just prior to the compliance date will be handled in order to ensure payment processing will occur—and more importantly—patients are covered financially and receive the best treatment. Identify critical areas or procedures that may be challenging to transition to using the ICD-10 and have practical resolutions for those practices ready to be executed if, and when, needed.

5. Obtain the correct medical documentation and update your forms to support the ICD-10.

Patient intake forms, EMR forms, insurance forms, and superbills must be updated to support the ICD-10 codes. In order to have patient medical records completed correctly and treatments performed effectively, in addition to have payments process, healthcare providers, clearinghouses, and payers must update their forms to reflect the codes in the ICD-10. Physician forms must be updated with the new medical terminology and diagnoses and procedural codes, along with superbills. Identify categories of uncommon services and diagnoses and determine units, time, and cost for each category in order for physicians to be able to report in the EMR and on superbills. Determine and have readily available a list of common or most frequently used abbreviations to ensure they are utilized correctly and correspondently with the ICD-10 terminology and codes. Lastly, and this goes without saying, obtain the updated and correct documentation that will stand as educational and reference material in regards to the ICD-10. The American Medical Association publishes the ICD-10 codebook and other supplementary documentation on topics such as anatomy and physiology, mappings, and coding workbooks. Make sure to have these ICD-10 Bibles available, and in all areas, for staff and physicians to reference when needed or desired.

The healthcare industry is about to embark on an intense change in treatment, reporting, and payment processes as the ICD-10 Compliance date approaches. While the ICD-10 is definitely necessary to reflect advances in medicine and detailed diagnoses, the change is extremely disruptive for healthcare providers. By employing efficient technologies and engaging effective strategies, healthcare providers can execute the ICD-10 transition quickly and accurately by the compliance date.  READ MORE

Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.  We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement


A Visual Guide to Medical Coding




As of October 1, 2015, there will be more than 144,000 codes that may be applied to patient “stories”

Medical coders provide a critical link between health care providers who are busy caring for patients, and patient insurance companies. Ensuring patient care “stories” are passed to insurance providers in ways they will honor.



Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.  We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement

MDS is excited to be a game-changer in the RCM industry!

The time is right!  Let us help reduce the stress incurred by claims denials and lost profits. We focus on your practice’s non-medical, business aspects giving you time to focus on practicing medicine.  EHR and RCM should work together and that is why we are offering the most competitive billing services in the industry!   Cash-flow is the lifeline of your practice and there is no reason to pay upwards of 12% on receivables.  This is damaging to your bottom line.

The burden cost of on-site billing can be more than costly;  it can be quite straining to the company creating weighted overhead.   Because time, money and resources are valuable assets,   MDS’ RCM Services provide the right solution.  We have certified, expert billing and coding staff to handle all operations of a patient encounter, securely and accurately. Our software dashboard(s) provide a process and visibility in real time, at the point of care.

Our staff and software support team have a combined 20+ years in billing service analysis, RCM, and business operations and review. Our experience in healthcare documentation with state-specific billing rules and regulations set us apart from others in the industry.   We KNOW our business.

Change Just Ahead Green Road Sign with Dramatic Clouds, Sun Rays and Sky.


Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, EHR technology, and REAL-TIME solutions.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. 


Medical Documentation (transcription) & ICD-10

So much buzz out there with M-Modal’s crappy news.  It is sad to see US jobs lost to off-shore (again).  It is very frustrating, as well as devastating, for those affected.  Now more than ever, it is important for MTs, the ones who really want to stay in this industry, to educate and re-tool, and just be diverse!  Be ready for whatever comes our way.  However, we are believers in dictation because we are listening to our physician friends.  We hear what they are saying and we are listening to insurance auditors for major companies.  Increased documentation is coming;  it will be sink or swim for some and many experts believe the only way physicians will survive is to go back to dictating.  Take some time and read the articles below.  They contain interesting information on why we could see a push-back on dictation.  The Affordable Care Act (Obamacare) and ICD-10 are key reasons.  Then you have the physicians who are tired of the clerical roles they have had to assume with EHR.

“These new changes will increase the need for skilled medical transcription and medical coding”  Read More. 

“Whether you are an advocate or a detractor of Obamacare, we do know that it is going to dramatically increase the required amount of documentation. Secondly, we know that the buzzword for ICD-10 (beyond the other buzzword “PAIN”) is “specificity.”  Read more.

“Assuming those medical transcription companies that are here today are still on the scene on Oct. 1, 2013, not having been acquired or retired, (and there certainly are fewer and fewer of them!)  I believe they will enjoy increased dictation with the changeover from ICD-9 to ICD-10.”  Read more.

The Perfect Storm!  Opportunities!