SAN ANTONIO, TX (PRWEB) MAY 15, 2017
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.
MDS understands that document specificity is critical for ICD-10. You do not want to see an interruption with your payors.
AAPC released recent study results showing clinical documentation of more than 20,000 physicians with only 63% of current documentation adequate to support the ICD-10 requirements. Predictions show one of the largest problems following the October 1, 2014 implementation date for ICD-10 will be documentation insufficient to support the specificity requirements.
By: Diane Taylor, RN-BC, EHR Intelligence
If you think ICD-10 is all about new codes, you are dead wrong. ICD-10 is really about “documentation” ─ we clinicians have learned from day one that, “If it’s not documented, it wasn’t done.” This situation is even truer in the ICD-10 world, where the coder must build the ICD-10 code based on the presenting story of that patient’s visit from admissions to discharge. With all the new code options, you never know what code will be built.
Case in point: The ED physician sees and diagnoses the patient with head and chest contusions and a fractured femur caused by a motor vehicle accident (MVA). The hospital admits the patient. The nurse, who documents the patient history assessment, discovers the patient hit the vehicle in front of her on a busy residential street. The therapist teaching the patient how to crutch walk discovers new information that the patient was driving home after a fight with her in-laws and was texting when the accident occurred. The entire story is now documented fully and ready for coding to add to the claim’s reimbursement.
A “MVA”, “on a residential street,” “texting while driving” and “fighting with in-laws” are all now capable of being coded. Even though 50 percent of the new ICD-10 codes are based on laterality, there are so many new codes that can be used. Documentation matters. Specificity matters.
Real-time documentation is especially important. Care managers will need to know the documentation is present and when the patient status changes from “Observation” to “Inpatient”. They can no longer wait for the end of the shift for clinicians to document. Medical necessity must be present; if not, queries sent to physicians will likely increase. Clinical documentation improvement (CDI) specialists will have to forward clarifications to physicians if information in the clinician’s note does not correspond with what the physician documented. The volume of queries overall is expected to increase substantially. If documentation is not entered in real time, the longer that information remains on the coder’s desk, the longer the time to attain revenue and reimbursement.
Users of electronic medical record systems also need to be able to document laterality as well as perform in-depth documentation for specificity. For example, a coder will need to receive a thorough description of the wound to understand where the insertion of the IV on the body occurred, the reason for the IV order and the medication administered. To be able to describe the location of injury (i.e., is it located left or right side or upper or lower part of the body?), distal or proximal, medial or lateral, and much more will be even more critical for ICD-10 coding.
Physicians working in medical practices or clinics are expected to experience difficulty adjusting to the new ICD-10 code sets. They will be responsible for providing hospitals with information in ICD-10 form to aid their peers. Clinic orders, such as lab and radiology, will need ICD-10 diagnosis so the hospitals can process these orders appropriately. If the coordination of this level of communication doesn’t improve, patient care and treatment can be affected and denials will surely increase.
So are you really ready for ICD-10? Apparently it’s not just a coding project.
Diane Taylor, RN-BC, Delivery Manager, CTG Health Solutions, is a healthcare professional with 30-plus years’ experience with a focus on clinical transformation and change management.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, 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.
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.
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.
Wichita, KS (September 19, 2013) – Wichita-based medical document services company, MDS of Kansas (MDS) joins forces with Azalea Health (Azalea) to provide clients with a billing service and complete cloud-based electronic health records (EHR) solution, Azalea EHR.
For over 22 years MDS has delivered a variety of medical document services, including transcription, editing, EHR integration, and education programs throughout the Midwest. “The merging of advanced technology with continued emphasis on efficient and accurate healthcare documentation has created new demands on physicians. We offer REAL-TIME solutions while helping to improve cash flow, margins and efficiency.” says Donella Aubuchon, CEO of MDS.
MDS chose to partner with Azalea Health to offer a full range of healthcare billing services and EHR solutions to its clients. Aubuchon explains, “The specificity of documentation in the health record significantly impacts the administrative and financial side of a practice.” Azalea’s cloud-based software suite comes with a quality support team and a fully-integrated billing and claims management module which boasts an increase in billing accuracy and aids practices in earning 15% more in reimbursements. In addition to accuracy, Azalea provides a secure portal for users to both record and transmit sensitive data.
About MDS of Kansas:
MDS of Kansas, L.L.C. is a small business located at 205 S. Hillside and offers Medical Transcription services, education programs for Medical Transcription and Medical Scribes, as well as Medical Billing & Coding services. For more information, visit www.MDSofKansas.com or call (866) 777-7264.
About Azalea Health
Azalea Health (Azalea) is a leading provider of cloud-based healthcare solutions and services. Azalea provides Electronic Health Records (EHR), Practice Management Systems (PMS), Electronic Prescribing (eRx), Laboratory Ordering and Resulting, Patient Health Records Portal, Telemedicine and Health Information Exchanges (HIE), as well as Revenue Cycle Management Services (RCM), and Precertification Services. For more information, visit www.AzaleaHealth.com or call (877) 777-7686.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, EHR technology, Medical Scribe education 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.