Coding Compliance Audits: Uncovering Deficiencies and Solutions

In an era where healthcare systems are intricately tied to digital platforms, meticulous coding accuracy cannot be a mere afterthought; it is an absolute necessity. Often overlooked, coding errors are the silent killers of compliance in the healthcare sector. This post delves into the ins and outs of auditing coding compliance. We aim to guide [...]

By |2024-03-07T18:41:51+00:00March 7th, 2024|

Outsourcing Medical Coding: The Key Advantages for Healthcare Providers

Amid the complex labyrinth of healthcare administration, one area stands as a beacon of efficiency and cost-effectiveness—outsourcing medical coding. It brings an exhaustive list of benefits ranging from unburdening clinicians, reducing compliance exposure, minimizing claim denials, and optimizing revenue capture.  This post dives into the compelling reasons why outsourcing medical coding can improve operations, maximize [...]

By |2024-03-07T18:48:57+00:00February 8th, 2024|

HCC Coding Compliance: Avoid Revenue Loss and Fines in Healthcare

Navigating the complex labyrinth of HCC coding is a daunting task for healthcare providers due to the frequent carrier changes to rules and regulations, and non-compliance could mean substantial revenue loss and hefty fines. In an era where healthcare services are under financial pressure like never before, unsurpassed accuracy in HCC coding has become an [...]

By |2024-01-26T02:46:23+00:00January 12th, 2024|

Medical Coding Audits: Ensure Accurate Clinical Documentation

Why Conduct a Medical Coding Audit Medical coding audits ensure accurate clinical documentation, improve revenue cycle management, minimize revenue loss and coding liability, and maintain compliance with industry regulations. Improved Accuracy of Clinical Documentation Accurate clinical documentation supports the quality of care delivered to the patients and the providers' medical coding, which translates diagnoses and procedures into [...]

By |2024-03-07T18:45:17+00:00December 1st, 2023|

DOJ alleges Kaiser Permanente defrauded Medicare of $1 billion

Kaiser Permanente and members of its healthcare consortium defrauded Medicare of nearly $1 billion by tacking on diagnoses to patients’ medical records to earn more in reimbursement payments, the Department of Justice claims in a complaint filed Monday. The DOJ alleges Kaiser looked through Medicare Advantage medical files and pushed physicians to retrospectively add new [...]

By |2021-11-02T03:41:19+00:00November 2nd, 2021|

CMS Selects Primary Care Payment Model Participants

CMS selects primary care payment model participants According to Becker's Hospital Review, "CMS chose 916 primary care practices and 37 regional health plan partners as participants in its new payment model called Primary Care First. PCF was designed to decrease the amount of avoidable hospital visits and total cost of care through performance-based adjustments. The [...]

By |2020-11-24T21:41:49+00:00November 24th, 2020|

OIG Tags Arizona Hospital for Erroneous Billing

OIG Tags Arizona Hospital for Erroneous Billing Flagstaff (Ariz.) Medical Center failed to comply with Medicare billing requirements for three of 100 inpatient and outpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report. The three claims that did not comply with Medicare billing requirements resulted in Flagstaff Medical Center receiving [...]

By |2020-11-12T21:58:55+00:00November 12th, 2020|

Neurosurgeon Medical Practice Director to Pay Over $1 Million

Neurosurgeon Medical Practice Director to Pay Over $1 Million Neurosurgeon Medical Practice Director to Pay Over $1 Million to Resolve False Claims Act Liability Arising from Billing of P-Stim Devices. PHILADELPHIA – First Assistant United States Attorney Jennifer Arbittier Williams announced that neurosurgeon Sagi M. Kuznits, practice director Pnina Kuznits, and Neurosurgical Care LLC (collectively, [...]

By |2020-11-12T21:54:38+00:00November 12th, 2020|

New Mexico Physician and Practice Settle Case Involving False Claims

New Mexico Physician and Practice Settle Case Involving False Claims The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using [...]

By |2020-11-12T21:54:10+00:00November 12th, 2020|

Texas Physician and Practice Settle Case Involving False Claims

Texas Physician and Practice Settle Case Involving False Claims The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS [...]

By |2020-11-12T21:53:15+00:00November 12th, 2020|