Category Archives: hospital coding
Report: 88% of 200+ Bed Hospitals Outsourcing Their CDI Realized …
88 percent of 200+ bed hospitals outsourcing their CDI currently report to have realized significant (over $1M) gains in appropriate revenue and proper reimbursements following the implementation of clinical documentation improvement program yet before ICD-10, according to the recently published Black Book survey. Additionally, 83 percent confirm quality improvements and increases in the case mix index. The survey of 650 hospital technology and physician leaders found outsourced coding and Clinical Documentation initiatives are showing signs of tripling in the number of hospitals contracting for external CDI services help before the October 1, 2015 deadline.
Currently, 24 percent of hospitals now outsource CDI audit, review and programming with 71 percent of hospitals planning on partnering with a CDI vendor to assist them with ICD-10 transition by Q3 2015. Also, 28 percent of hospitals presently outsourcing coding and CDI are contemplating a switch to second generation CDI vendors as physician practice acquisitions and EHR implementations have threatened the sustainability or effectiveness of their current CDI programming.
Other key findings in the report include:
– Nuance Communications ranked with the highest client experience and customer satisfaction scores on eighteen key performance indicators among currently implemented end-to-end CDI clients. Other top scoring vendors included 3M, Optum, The Advisory Board, Navigant, Chartwise Medical, Precyse and DCBA.
– Transcription services, already outsourced by 63 percent of hospitals, is also expected to grow to over 70 percent of providers as the ICD-10 deadline approaches.
– The top ranked vendor in client experience and satisfaction of outsourced transcription services is Precyse.
– Streamline Health ranked first in Content Management and Abstracting services.
– 19 percent of all hospitals confirm they are outsourcing coding already. However, by the new code deadline, that number is anticipated to grow to 47 percent of hospitals by the providers polled.
– 3M HIS ranked first in Computer-Assisted Coding (CAC) services.
Hospitals increasingly plan to outsource coding efforts
Outsourced coding and Clinical Documentation Improvement initiatives indicate signs of tripling in the number of hospitals contracting for external CDI services help before the October 1, 2015 deadline, according to the recently published Black Book™ survey of 650 hospital technology and physician leaders, found in the reports “Top Ranked Clinical Documentation Improvement Vendors”.
24 percent of hospitals now outsource Clinical documentation audit, review and programming. By Q3 2015, 71 percent of hospitals plan on having a CDI services partner help them adjust and survive under the new codes.
“There is no greater opportunity on the providers’ horizon to maximize financial viability than to improve the accuracy of provider clinical documentation,” said Doug Brown, Managing Partner of Black Book™.
88 percent of 200+ bed hospitals outsourcing CDI currently report to have realized significant (over $1M) gains in appropriate revenue and proper reimbursements following the implementation of clinical documentation improvement program yet before ICD-10. Additionally 83 percent confirm quality improvements and increases in the case mix index.
28 percent of hospitals presently outsourcing coding and CDI are contemplating a switch to second generation CDI vendors as physician practice acquisitions and EHR implementations have threatened the sustainability or effectiveness of their current CDI programming.
Nuance Communications ranked with the highest client experience and customer satisfaction scores on eighteen key performance indicators among currently implemented end-to-end CDI clients. Other top scoring vendors included 3M, Optum, The Advisory Board, Navigant, Chartwise Medical, Precyse and DCBA.
Transcription services, already outsourced by 63 percent of hospitals is also expected to grow to over 70 percent of providers as the ICD-10 deadline approaches. The top ranked vendor in client experience and satisfaction of outsourced transcription services is Precyse.
Read the Fierce Health IT article by clicking here.
Genetics of cancer: Non-coding DNA can finally be … – Medical Xpress
Cancer is a disease of the genome resulting from a combination of genetic modifications (or mutations). We inherit from our parents strong or weak predispositions to developing certain kinds of cancer; in addition, we also accumulate new mutations in our cells throughout our lifetime. Although the genetic origins of cancers have been studied for a long time, researchers were not able to measure the role of non-coding regions of the genome until now. A team of geneticists from the University of Geneva (UNIGE), by studying tissues from patients suffering from colorectal cancer, have succeeded in decoding this unexplored, but crucial, part of our genome. Their results can be found in Nature.
To better understand how cancer develops, scientists strive to identify genetic factors – whether hereditary or acquired – that could serve as the catalyst or trigger for tumor progression. Until now, the genetic basis of cancers had only been examined in the coding regions of the genome, which constitutes only 2% of it. However, as recent scientific advances have shown, the other 98% is far from inactive: it includes elements that serve to regulate gene expression, and therefore should play a major role in the development of cancer.
In order to better understand this role, Louis-Jeantet professor Emmanouil Dermitzakis and his team, from the Department of Genetic and Developmental Medicine in UNIGE’s Faculty of Medicine, studied colorectal cancer, one of the most common and most deadly cancers. Indeed, each year, one million new cases are detected around the world, and for almost half of these patients, the disease will prove fatal. Using genome sequencing technology, the UNIGE geneticists compared the RNA between healthy tissue and tumor tissue from 103 patients, searching for regulatory elements present in the vast, non-coding portion of the genome that impact the development of colorectal cancer. The goal was to identify the effect, present only in cancerous tissue, of acquired mutations whose activation would have triggered the disease. This approach is totally new: it is the first study of this scale to examine the non-coding genome of cancer patients.
Unknown Mutations
The UNIGE team was able to identify two kinds of non-coding mutations that have an impact on the development of colorectal cancer. They found, on one hand, hereditary regulatory variants that are not active in healthy tissue, but are activated in tumors and seem to contribute to cancer progression. It shows that the genome we inherit not only affects our predisposition towards developing cancer, but also has an influence on its progression. On the other hand, the researchers identified effects of acquired mutations on the regulation of gene expression that affect the genesis and progression of colorectal tumors.
‘The elements responsible for the development and progression of cancers located in the non-coding genome are as important as those found in the coding regions of the genome. Therefore, analyzing genetic factors in our whole genome, and not only in the coding regions as it was done before, gives us a much more comprehensive knowledge of the genetics behind colorectal cancer,’ explains Halit Ongen, the lead author of this study. ‘We applied this completely innovative methodology to colorectal cancer, but it can be applied to understand the genetic basis of all sorts of cancers,’ underlines Professor Dermitzakis.
Explore further:
Gut microbes turn carbs into colorectal cancer
More information: Nature DOI: 10.1038/nature13602
Online Medical Coding Course | Medical Billing Career Training
What is medical billing?. Medical billing is the meeting point between the realms of health insurance and professional health facilities.
Every time a person with active health insurance makes use of medical facilities that cover his insurance policy; it is the role of a professional medical billing person to create the claim for payment, contact with the insurance companies for the reimbursement of the claim funds and handle any issues or unusual events during the entire billing procedure. Upon completion of the claim a receipt or acceptance docket has to be supplied by the insurer.
While most medical facilities now make use of intelligently designed billing software; the need for professional medical billers is still great; particularly for the purpose of managing the software programs and being responsible the entire billing and coding task.
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Level 3:Advanced Coding Online Available at aaoms.org Course Overview: This course presents some of the more challenging aspects of coding for the
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Will Obamacare increase personal medical bankruptcies?
Will Obamacare increase personal medical bankruptcies?
Despite its rocky rollout it’s clear now that Obamacare is succeeding in bringing medical insurance to many of America’s uninsured. According to a recent Gallup poll, the uninsured rate fell to 13.4 percent in the second quarter of 2014. It peaked at 18 percent in the 3rd quarter of 2013. This is the lowest quarterly figure since Gallup started tracking medical insurance enrollments in 2008. The Commonwealth Fund reports that as of May 1, 2014, 20 million people now have coverage under the Affordable Care Act. The largest number of enrollees, 8 million, purchased insurance directly through government run health insurance marketplaces, 6 million through Medicaid or CHIPS, 5 million from an insurer, and the remaining 1 million young adults under 26 enrolled in their parents’ plans. This is a remarkable success, especially given that 20 states are still firmly set against extending Obamacare to their Medicaid recipients.
At this point we can expect to see the uncharted shoals of Obamacare begin to emerge. For example, common wisdom is that the often comparably low monthly premium covers all, after the usual clearly stated deductibles, exclusions and coinsurance. This isn’t true, of course: the ACA isn’t National Health. It’s a pastiche woven from compromise.
Many of those freshly enrolled in Obamacare are newcomers to the medical insurance arena and are unaware of coverage pitfalls. Nowhere is this more dramatically clear than when balance billing issues arise. In balance billing, providers charge patients the full market rate for services. This often occurs because the patient, unbeknown to him or her, has been treated by a practitioner outside of the patient’s insurance network, be it PPO, HMO, or, increasingly an EPO. The New York Times last year chronicled the financial catastrophe that can befall patients and their families when balance billing comes into play. “It’s not uncommon for patients who visit an in-network hospital to learn later that they’ve been treated by out-of-network providers, resulting in thousands of dollars in charges,” notes the article, “Out of Network, Not by Choice, and Facing Huge Health Bills.”
Under Obamacare, as with traditional plans, patients referred by their in-network practitioners to a specialist who’s not in their network can end up with huge unforeseen bills. Likewise, in-hospital services are often provided by physicians unknown to patients or even unseen by them, such as anesthesiologists, radiologists, pathologists. Overwhelming bills can come from them, to.
The ACA does make some provision for balance billing in emergency services, but otherwise not, notes The Times. “It is conceivable that the problem gets worse for some people if the Affordable Care Act encourages narrower networks, which some people think it might do,” said health care law expert Professor Timothy S. Jost.
Evidence is emerging that Prof. Jost is correct. Obamacare seems to be sparking the growth of EPO’s—Exclusive Provider Organizations—into which insurance carriers are moving Obamacare enrollees. EPOs typically have fewer participating providers and offer less coverage. California’s Anthem Blue Cross is facing a potential class action suit over what The Los Angeles Times tagged as “more litigation over narrow networks in Obamacare coverage.” Anthem’s Obamacare subscribers allege they were surreptitiously moved from Blue Cross PPO’s into EPOs, and so inappropriately subjected to balance billing. Some of the Obamacare enrollees had prior PPO coverage, and believed they still did.
One out of three Americans have trouble pay their medical bills. Medical bankruptcies constitute 62% of personal bankruptcies in the US, according to the Kaiser Family Foundation. Most who filed for “were well educated, owned homes, and had middle class occupations. Three quarters had health insurance,” noted the Foundation.
We’re seeing millions of new, unsophisticated medical services’ consumers coming into the marketplace through Obamacare enrollment. Most are largely unaware of medical billing nuances, such as balance billing. It’s possible over the next few years that because of this we’ll see an increase in medical bankruptcies. Studies of Obamacare’s forerunner, Massachusetts’s Romneycare, showed that medical bankruptcies in that state were largely unaffected by Romneycare. In 2007-09, medical bills “contributed to 52.9% of all bankruptcies in the state. Absolute numbers of medical bankruptcies were up by a third,” reported The American Journal of Medicine.
One out of three Americans have trouble paying their medical bills. Medical bankruptcies constitute 62% of personal bankruptcies in the US. Most medical bankrupts “were well educated, owned homes, and had middle class occupations. Three quarters had health insurance,” according to the Kaiser Family Foundation.
Unless and until the Obamacare legislation is modified to account for all aspects of balance billing, medical bankruptcies will rise if not soar.
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Refresh Your Injection and Infusion Hospital Coding: Audio Educator
Click here for more Information: http://www.audioeducator.com/medical-coding-billing/cpt-coding-07-10-14.html Refresh Your Injection and Infusion Hospital Co…
St Paul Nurse Practitioner Critical Care Job – MN, 55101
Evaluates and treats hospitalized patients with a specific focus on critical and intensive care.
Provides direction in emergent situations in the Intensivists absence. Provides education to and is a resource for the nursing and resident staff.
Ensures assigned patients are properly and efficiently admitted and receive appropriate and responsive medical care according to their condition, symptoms and diagnosis. Develops a plan of care in conjunctions with other primary and specialty physicians and interdisciplinary staff to ensure quality care of patients. Complete effective and timely verbal communication with primary and specialist physicians.
Communicates with patients and families to explain diagnosis, procedures, expected diagnostic or therapeutic treatments, prognosis and/or recovery periods, and potential or expected outcomes; and to obtain informed consent. Proactively communicates with other clinicians in order to effect a coordinated and timely transfer of information necessary to advance quality care and outcomes for outpatients.
Collaborates, consults and communicates with a multidisciplinary team of healthcare providers and staff throughout the continuum of care.
Participates in assigned work teams, co-management committees and HealthEast department meetings to develop programs, protocols and assist in the overall improvement of quality of care and operations. Attend Intensivist staff meetings and other meetings as assigned.
Documents patient H & P, diagnosis, treatment, orders and clinical progress in the chart, in order to allow for complete collection of co morbidity and complication information for use by hospital medical records and coding staff. Dictates discharge or transfer of care summaries within 12-24 hours of discharge or transfers to allow for timely communication. Returns pages and phone calls in a timely fashion to clarify orders, arrange transfers, follow-up on tests and answer patient, family and staff questions.
Submits charges daily. Obtains 12 hours coding education per year. Meets with coding educator monthly to review coding profile and identify opportunities for improvement around documentation. Responds to coding feedback requests within 5 days.
Maintains confidentiality in all aspects of the job.
Performs all other related duties as assigned.
Electronic health records don't increase Medicare fraud, study finds
ANN ARBOR—Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher health care spending are unfounded, according to a study from the University of Michigan School of Information and the Harvard School of Public Health.
Following the passage of the HITECH Act in 2009, more than 5,000 hospitals became eligible for financial incentives to adopt and engage in “meaningful use” of electronic health records. Early results show that more than half of all eligible hospitals have qualified for incentives. The Act was motivated by the expectation that electronic health record use would improve the quality of care and reduce costs by avoiding inefficiencies, inappropriate care and medical errors.
However, some experts have suggested that the increased documentation abilities of electronic health records could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up health care costs by documenting and billing for care that did not occur.
The study, by Julia Adler-Milstein, U-M assistant professor of information, and Ashish K. Jha, Harvard professor of public health, is published online in the July issue of Health Affairs.
“There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn’t,” said Adler-Milstein, who is also an assistant professor of health management and policy in the U-M School of Public Health.
To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted electronic health records had greater subsequent increases in the severity of patents’ conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.
Despite widespread stories and concerns among policymakers about the potential for electronic health records to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.
With no empirical evidence to suggest that hospitals are systemically using electronic health records to increase reimbursement, the study’s findings should reduce concerns that EHR adoption by itself will increase the cost of hospital care.
The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce health care spending and improve the quality of care.
The paper is titled, “No Evidence That Hospitals Are Using New Electronic Health Records to Increase Medicare Reimbursements.” Health Affairs is a peer-reviewed journal focusing on health policy thought and research. The study will be published in an upcoming print edition of the monthly journal.
Related Link:
- Julia Adler-Milstein:www.si.umich.edu/people/julia-adler-milstein
1 Boring Old Man » all databases are not created equal…
These data were drawn from two countries with different suicide rates, different practice patterns, and different hospital payment schemes, which may translate into differences in coding practice. In addition, there is variation in …