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Supercoders Offer Efficiency in the Transition to ICD-10

The transitionto ICD-10 brings with it the necessity to train staff on the new coding procedures and new terminologies. This is the only way to make sure that records are accurate and the risk for denied claims is minimized. Most practices understand the need to train coding staff in the new terminologies or to hire third parties to do their coding and billing for them. Coders differ in the level of training, skill and expertise, which means that one coder may be best for entry-level coding involving general medical information, while a more experienced coder with higher training may be suited for more complicated medical procedures. However, there's a difference of opinion regarding the need for regular coders and specialized coders, or those who are experts at coding for specific procedures or conditions. Read on:

What Coders Do Coders are required to have an intensive background on medical terminology in order to provide an accurate description of health services delivered to the patient through ICD-10 documentation training. Due to the precise nature of medical language, coders are trained to recognize medical terminologies that cover anatomical terminology, procedural terminology, abbreviations, and descriptions, and to be knowledgeable about the codes and descriptions that match them. With the right training, coders and billers can make the difference between approved and denied claims. Introduction to Supercoders: What are they? Supercoders are coding professionals who have mastered specialized codes for specific diseases and conditions. These are coders with the best technical skills on the subject of ICD-9 and ICD-10 documentation. Many hospitals see the need for a dedicated specialized coder, particularly in departments that handle complicated procedures and conditions. For example, dedicated coders in the surgery department receive training that enables them to identify procedures and detect documentation anomalies. Dedicated coders may also work with surgeons to improve documentation on the part of the doctors, and that translates to more accurate and efficient results. Best Environments for Supercoders Supercoders and their unique set of skills will prove to be useful during transition periods, when increased accuracy is critical. They will also prove most useful in situations where complicated procedures and terminologies are commonplace. For example, surgical procedures for the treatment of rare medical anomalies will require the coding proficiency of those who have specialized training in these fields. Their skills will also prove useful when appealing a denied, down-coded, or incorrectly paid claims. While physician documentation training ensures that doctors also know how to document procedures according to the new system, coder training ensures that doctor records are translated appropriately. Experts recommend providing coding staff with the right amount of training that will allow them to develop into supercoders who can deal efficiently with both general and specific medical documentation. This flexibility ensures accurate coding no matter what procedure or condition is involved. Contact Provident Edge to learn more about supercoders, specialized coding, and the looming transition to ICD-10.

#icd-10 #supercoders #clinical documentation education

What We Can Learn from the ICD-10 Implementation in Canada

Canada’simplementation of ICD-10 documentation offers U.S. hospital administrators a number of important lessons. The Canadian single-payer system started the implementation of the ICD-10 coding implementation, among various provinces, in stages from 2001 to 2004. As hospital administrators work toward ICD-10 coding compliance, the following offer vital lessons:

#icd-10 #clinical documentation education #physician advisor

ICD-10 Compliance: Pros and Cons of In-House Coding

With the transition to ICD-10 documentation comes the decision of how to manage staff training to enhance skills and competencies to meet the new demands of the new system. There are good arguments for in-house staff and physician documentation training, while other institutions are also seeing the benefits of outsourced medical coding. Here's a balanced look at both options and how each may suit specific healthcare scenarios:

Pros and Cons of In-House Medical Coding One of the most important advantages to in-house medical billing would be the degree of control that management has over processing of claims, especially when they have trusted and long-term employees at the helm. And while coding and billing training for in-house staff may initially be costly for any health clinic or hospital, it will eventually yield a return on investment in terms of a more skilled veteran staff and smoother operations. For many hospitals, training may not be too extensive if they already have an efficient coding and billing system that just needs to be refined or tweaked to meet the demands of ICD-10. Another advantage is the close proximity of the coding and billing staff to management. Perhaps the most obvious disadvantage is the cost that comes with training staff and the purchase and installation of new hardware and software. Having an in-house billing and coding department also puts more pressure on management to keep a strict eye over billers and coders to avoid anomalies such as embezzlement and employee neglect which could result to delayed or failed claims, or worse, lawsuits. Pros and Cons of Outsourced Coding One of the most obvious benefits of outsourcing is the opportunity to work with an expert staff, an excellent option for organizations whose in-house coders do not have a high degree of skill. Independent management companies are composed of highly skilled workers who have received proper training in ICD-9 and ICD-10 coding systems. Utilizing such coders minimizes the risk for coding errors and ensures high reimbursement rates. There is also a shorter waiting time for reimbursements because you are working with a team that is focused solely on coding and billing. Another advantage to outsourced coding includes the savings in processing costs. Staff training costs man hours and money which not every clinic or hospital is willing (or able) to spend. While billing and coding experts charge a flat fee or a percentage of claims processed, healthcare units still enjoy savings in expenses for billing staff and other office expenses. Most importantly, outsourcing coding and billing tasks frees the in-house staff to focus more on the delivery of quality patient care, and it also contributes to a more efficient operation because specialized tasks, especially billing and coding, are handled by the personnel who are best equipped to handle them. Outsourcing, however, does not come without its own weak spots. For example, it may be hard to monitor progress of claims when working with a third party. The decision to outsource coding and billing is also accompanied by the fact that management may have to eliminate the in-house billing and coding positions, or the staff manning these posts may need to be reassigned or retrained for other jobs, which also costs money. Contact Provident Edge to determine the best coding options for your organization. Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] (248) 957-0123 http://www.providentedge.com

#icd-10 #clinical documentation education

Final Steps in Preparing for the ICD-10 Transition

The time has come to make sure that all processes related to patient documentation and care are fully compliant with the ICD-10 new system. Most healthcare organizations are focused on staff training and the installation of new software, but many neglect final testing and assessment to ensure that all training and preparation goals have been met. Here are the most important last-minute preparation areas that need to be checked off before making the switch to ICD-10.

Assess training outcomes via internal and external tests After coding personnel and physicians have undergone clinical documentation training in the new coding system, it is important to evaluate their competencies to ensure that they are prepared for the switch. Practical and hands-on evaluations are a must, particularly for coders and billers. Non-coding staff also should be trained, especially in the area of workflow changes. Proficiency in the new system means fewer coding mistakes, and that translates to fewer denials and a more efficient claims processing system. It is equally important to complete external testing—and the sooner, the better. Conduct tests with the parties that receive claims, bills, and verify that your external partners and payers are ready. Determine how to assess claims denials An increase in claims denials is an expected results of the transition. It is important for hospitals and other healthcare providers to have a system for assessing claims denials to solve these problems at the earliest possible time. For example, knowing whether it's a billing or payer problem enables the provider to come up with solutions at the earliest possible time. Conduct a final pop quiz Experts recommend giving occasional trial runs during the months prior to transition to assess staff readiness for ICD-10 documentation. A final pop quiz is a good way to get a final assessment of how prepared staff is for crunch time. And it's a great time to give out rewards for jobs well done. Prepare extra cash revenue Experts recommend that providers have extra cash revenue available to make sure finances remain viable through the transition. While fears of bankruptcy are exaggerated, it is expected that practices will experience a significant dip in revenue as they transition. Still apprehensive about the switch? You are not alone. Every other healthcare unit and provider out there is in the same boat. Start your preparation months early so that when you do a final evaluation, you will see that you have covered all the bases in time for the switch. Contact Provident Consulting for step-by-step assistance with the looming ICD-10 transition.

#icd-10 #clinical documentation education #claims denials

Chiropractors Impacted by ICD-10 Transition

As ICD-9 transitions to ICD-10, medicalpersonnel are scrambling to incorporate the new coding compliances into their medical practices to create a new set of clinical guidelines. These changes have affected many entities working in the medical field, including chiropractors, and will alter the procedures that are currently in place.

#icd-10 #dual coding

Make a Smooth Transition to ICD-10 with Dual Coding

The transition to ICD-10 poses a number of challenges for healthinstitutions, physicians, and coders. The problem lies mainly in the need to spend resources, particularly in the form of personnel and time, in order to familiarize staff with the new set of codes that are an expansion and improvement of the older system. Dual coding is seen by experts as the answer to the problem of how to minimize the impact of the transition and to avoid risks involved with claims testing once the code is fully implemented in October 2015.

More accurate testing. Dual coding enables organizations to start testing critical areas in clinical documentation. This helps organizations conduct tests on a bigger set of data for better, more accurate results. This also helps enable financial modeling so providers can determine how they can closely collaborate with payers and how certain diagnosis-related groups may be weighted. This also facilitates a closer inspection of how the new codes will affect reimbursement and what changes are necessary, such as more comprehensive documentation for effective coding compliance. Early Preparation. Dual coding allows for more accurate predictions of how ICD-10 will impact productivity, staffing, and documentation, along with what changes are needed for improvement. This enables organizations to identify training needs and to facilitate training early. Early preparation with dual coding also helps with familiarity. Coders who dual-coded as early as a year before transition already have a high level of familiarity with the new code so that when full transition occurs, they no longer have to deal with such a steep learning curve. This advantage also extends to physicians. While physicians are not expected to learn as much detail as coders do, the documentation they provide can make a large difference. Early preparation helps coders talk to physicians so the latter have more time to prepare and get acquainted with the system and provide more accurate documentation during the dual coding stage. Vendor Readiness. Organizations can mitigate the effects of transition when vendors are also fully compliant. Vendor readiness is an important factor, and providers can use dual coding to evaluate vendor readiness and support, especially in the specific mechanics and processes for coding in both ICD-9 and ICD-10. Important areas to consider for dual coding include abstracting, data capture and time studies, and how vendors are equipped to provide support in these areas. It is only when vendors are ready that organizations can successfully implement dual coding and conduct accurate claims testing, so vendor participation and compliance should be obtained as early as possible. The transition to ICD-10 is expected to result to lower productivity by as much as 30 to 60 percent in the first few months, especially for small- and medium-sized health organizations. The worst-case predictions say that there is a possibility that some organizations may never fully recover. Advanced preparations and the utilization of dual coding practices, however, can help mitigate risks and help organizations and providers facilitate an efficient and revenue-neutral transition. Contact Provident Consulting to start preparing now for the October implementation of ICD-10.

#dual coding #icd-10

Potential Effects of ICD-10 Implementation on Coder Productivity

ICD-10 is the tenth revision of the InternationalClassification of Disease coding system that was developed by the World Health Organization (WHO). The successor to the ICD-9 coding system notes a number of medical records and includes diseases and their symptoms, abnormal findings, and external injury causes. In the U.S., the deadline for ICD-10 coding compliance is October 1, 2015.

Impact of ICD-10 Implementation on Coder Productivity Experts in the field of health management are of the firm opinion that implementation of the ICD-10 system will impact the entire spectrum of healthcare and, specifically, the area of coder productivity. There is high level of complexity associated with ICD-10 documentation and a serious lack of familiarity regarding the new system requirements. The productivity of staff members who document, determine, record, or use an ICD-10 diagnosis/procedure code will be drastically reduced while staff members adjust to using new software, codes, and follow procedures. The impact of the system will be more evident in the department of health information management (HIM) as the main job of a coder working here will be determining the codes that are to be used. The number of codes in ICD-10 is about five times greater than that of the ICD-9 system. Disease classifications are in double digits. Further, the number of codes for inpatient hospital procedure alone will jump from 3,000 in ICD-9 to as many as 87,000 in ICD-10. Impact of ICD-10 Implementation On Coder Productivity – What Do Studies Indicate It is difficult to make a precise estimate with regards to the impact of the ICD-10 implementation on productivity. Replacing diagnosis and procedure codes, on a scale as large as this, has not been attempted before. Studies published as part of the transition to the ICD-10 system in Canada (Humber River Regional Hospital in Ontario) and efforts made in the U.S. (AHIMA ICD-10 Field Testing Project and HIMSS/WEDI ICD-10 National Pilot Program) provide at least some basis for determining the impact of implementation of the new system on coder productivity. These studies, as well as other data, indicate that coding productivity is likely to decline by as much as 50 percent initially. Further, it will take a minimum of six months for the productivity to start getting back to normal levels. At the very best, some organizations may achieve a productivity level that is 80 percent of that which existed prior to ICD-10 implementation. The decline in productivity, combined with the expansion of the healthcare sector as baby boomers come of age, may contribute to a permanent loss in coder productivity. Further, healthcare organizations should begin preparing now for the ICD-10 implementation to avoid serious problems (and tremendous financial implications) resulting from waiting until the October start date. Contact Provident Consulting for help with the implementation of ICD-10.

#icd-10

How Claims Denials Will Be Affected by the ICD-10 Transition

According to studies, the cost of impact of the transitionto ICD-10 documentation could cost a practice as much as $83,000 to $2.7 million for staff education and training, changes in contracts, coverage determinations, the need for increased documentation, changes in IT and data storage systems and, of course, the possible cash flow disruption that comes when claims are not approved right away. It is also important to note that there is predicted increase in the amount of time needed to be spent by physicians on documentation alone—a permanent increase and not merely a transitional learning curve. This naturally adds to the physician's workload in order to comply with a more specific, more complicated coding requirements, which help ensure that claims are processed and approved.

Impact of Claims Denials Claims and payments are two of the areas predicted to be greatly affected by the ICD-10 transition. Experts predict that there will be an upsurge in the number of rejected claims due to coding errors and the greater scrutiny employed by Medicare and commercial payers. This could translate to revenue losses and delayed payments. Increased denials also means that there is a need for a higher level of expertise when it comes to dealing with denials. Experts point out that denials will no longer require a simple clarification that can be handled by non-medical personnel. Increased complexity will require the participation of skilled coders who are familiar with the new code as well as physicians who must be available to provide medical clarification and input when needed. How to Mitigate Claims Denials During the ICD-10 Transition While testing and training for compliance is a must for healthcare practices and other institutions that will surely be affected by the transition, it is equally important to take steps to ensure revenue integrity during this time. This means minimizing denials by doing claims testing months before ICD-10 goes online and putting a specific person or team in charge of tracking claims denials, contacting insurance plans, making necessary corrections, and resubmitting denied claims. The first choice would be to hire a new staff members but this can be cost prohibitive, particularly for smaller outfits. This is why early training of existing coding personnel is crucial to lower transition costs and ensure that someone is in place to handle the specific needs of claims denials for ICD-10. The same person, or the team leader, should be responsible for filing claims within the filing dates to avoid processing backlogs that could further worsen the problem of delayed approvals for claims. High-volume and high-dollar claims, which account for the bulk of the revenue of larger institutions, should be closely monitored and dual coded to ensure accuracy. Practices are encouraged to select young, detail-oriented staff who already have experience in coding. Administrative and clerical personnel can be groomed, given the right training and time—the best option would be clerical staff with a clinical background, since they already understand anatomy and diseases processes. Again, this is where the usefulness of early training comes in. Contact Provident Consulting to prevent problems with the ICD-10 transition and claims denials.

#icd-10 #claims denials

Internal Audits and ICD-10 Compliance

Improvements in healthcare policies and the loomingtransition to ICD-10 affect healthcare institutions and providers who must follow regulations in terms of patient assessment, documentation, coding, and billing. Healthcare institutions and providers are doing their homework or are immersed in the middle of implementing the changes required by their compliance plans, both to improve services and to pass the expected Medicare compliance audit. These tests, audits, and reviews are recommended not just as one-time exercises, but rather as exercises that must be performed periodically the date of implementation on October 1, 2015 nears.

#icd-10 #clinical documentation education

Medical Community Braces for Launch of ICD-10

The newly announced compliance date of the ICD-10 on October 1, 2015, promises to be one of the mostkeenly observed events in the health and medical calendar this year. Implemented and administered by the U.S. Department of Health and Human Services (HHS), the 10th edition of the International Classification of Diseases (Clinical Modification and Procedure Coding System) is expected to feature significant changes compared to ICD-9-CM.

INITIAL ICD-10 ROLLOUT OPPOSITION The ICD-10 was initially expected to be rolled out in October last year to complement the launch of the Affordable Care Act’s health insurance exchanges. In addition, the ICD-10 is compulsory for treatment of American citizens covered by the Health Insurance Portability Accountability Act (HIPAA). However, the projected 1000 percent expansion of ICD-10 codes to approximately 155,000 codes has alarmed the medical community. After an intense lobbying effort spearheaded by the American Medical Association (AMA), the federal government agreed to extend the compliance date by one year to give time for the medical community to adapt to the new system. Nevertheless, the AMA is still concerned about the ICD-10 documentation requirements, especially since all Medicare claims will be processed and paid using the ICD-10 codes. COST AND CODES Beyond updating billing and service software, medical health personnel are also expected to familiarize themselves with the bulky new coding system for manual entries. It would even necessitate physician documentation training. In a report, “Look Out, Docs: Here Comes ICD-10”, the Wall Street Journal claimed that the current five codes for ankle injuries will rise to 45 under the new system. As such, the impact of coding errors is expected to hit the insurance industry hard. The Centers for Medicare and Medicaid Services (CMS) anticipates that up to 10 percent of claim insurers will return to their physicians over coding-related errors. Critics variously estimate that migration, adoption, and training-related costs of ICD-10 code sets could rise to as high as $2 billion. The AMA believes the figure will be higher, arguing that the implementation of the ICD-10 by small medical practices will cost anywhere between $56,639 and $226,105. THE CASE FOR ICD-10 Nevertheless, some industry observers believe the ICD-10 is long overdue, considering that the system currently used dates back to the 1975. The manifold medical and technological increases since then requires a more accurate and current system to ensure higher service and efficiency levels, on both the front and back ends. Further, in a press release last year, the CMS argues that the utilization of ICD-10 will enable physicians to capture much more patient data, facilitating better understanding of patients’ present and historical condition, particularly in referral cases. The improved data will also allow researches and health officials to track diseases and health trends much more effectively.

#icd-10

Patient Management Aided By Case Management Expertise

A highly regulated healthcare system is bound to create complex systems for patient status management. Healthcare institutions and medical workers are already required to provide round-the-clock observations and thorough documentation of patient status from the moment a patient enters the hospital or clinic through the time of discharge. This is a complex and labor-intensive process which requires the skill and knowledge of well-trained medical case managers.

#icd-10 #two-midnight rule #clinical documentation education

Understanding ICD-10

The ICD-10 is the 10th revision of disease classification authorized for publication by the World Health Organization. The ICD coding system was created for mortality coding and classification of death certificates, and although ICD-9 is currently being used in the classification of disease and injuries in clinical settings in the U.S., the transition to the new system has been ordered and every entity in the medical field to be affected.

#icd-10 #clinical documentation education #physician advisor

ICD-10 Will Have a Significant Impact on Your Bottom Line

The switch to ICD-10 affects physicians in areas far beyondmere documentation. Billing and coding changes are required, which translates to added costs and cuts into the revenue cycle. These include charging and pricing, documentation, software and computer systems, data order entries, and computer-assisted coding, all of which can be covered by a DRG audit for DRG validation for compliance.

Regulatory Changes —Decreased Profits — Increased Billing — Reimbursement Difficulties While the transition to ICD-10 is seen as a necessary move that makes patient care and reimbursement more efficient for all parties involved, it cannot be denied that policy and regulatory changes will result in decreased earnings during the transition phase. The adjustment period will also likely be accompanied by compliance problems as physicians and hospitals work with a new set of codes. Additional costs for training and a loss in profits resulting from lost working hours that are instead spent on training coding and medical staff also fall on the shoulders of these practitioners and their practices. Billing Billing refers to late charges, electronic data interchange, the use of transaction codes, and other transactions such as cash collections and reimbursements. A specific area in billing that will be most affected are the clinical editing systems that identify and correct coding errors. A crucial preparatory step would be to upgrade these systems and conduct tests all the way up to implementation. Coding Coding-related denials are expected to go up during the transition phase, and the task of translating ICD-9 codes to ICD-10 will not always work due to misaligned clinical equivalency. Policy changes related to coding will directly impact the revenue cycle. Practitioners, along with their coding and billing staff, have a lot of preparation ahead of them, since ICD-10 contains more codes than ICD- 9-CM. Other changes include added or revised definitions, changes in code sets from numeric to alphanumeric, and changes in the payment processes. As coders adjust to the new system, the time it takes to code a patient record is expected to increase given the higher level of specificity required by ICD-10. The increased length for documentation is also significant since it means that there could be an increase in the number of charts on hold for documentation as physicians take longer time documenting for each patient.

#icd-10 #clinical documentation education

Importance Of Denial Claims Management in Healthcare

Contact Provident Consulting to get your denials managers in place before October 2015.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] (248) 957-0123 http://www.providentedge.com

#icd-10 #physician advisor

Understanding The Impact Of ICD-10 Diagnosis Codes

Physicians, Nurses and Other Healthcare Providers Physicians and other healthcare providers are directly affected by the switch because they and their staff will need to learn about changes in ICD-10 and the added codes that will be used to code a diagnosis. Doctors, nurses, and staff will need to update their knowledge of these codes, particularly those that they use most often. This helps ensure the accuracy of claims and that the right claims go to the right payers.

Health Insurance Providers Health insurance companies, including Medicaid and Medicare, are considered the payers. They are affected because they need to reevaluate the standards for medical necessity. These companies must take steps to make sure that the transition from ICD-9 to ICD-10 goes smoothly and to prevent problems such as double-billing, which could happen when a billing includes both ICD-9 and ICD-10 codes.

Clearinghouses These are the middlemen that connect physicians with paers. They sort and organize claims, a task done by a coding and administrative staff that must be acquainted with the new set of medical diagnosis codes.

Knowing who will be affected is crucial in order for affected agencies to prepare and have a clear list of expectations when the switch to ICD-10 occurs. For example, experts tell doctors with orthopedic practices to expect a decrease in productivity when they switch. There is a need, therefore, for in-depth education and training in order to facilitate a smooth transition from the old to the new code. Clinical documentation education of hospital administration personnel which is best provided by hospital administration consulting firms is crucial to reduce the negative effects of the switch such as delays in claims processing and increase in the number of rejected claims because of inaccuracy or ambiguity.

Contact Provident Consulting to prepare for the implementation of ICD-10.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] (248) 957-0123 http://www.providentedge.com

#icd-10 #physician advisor

Stay Up-To-Code With Clinical Documentation Education

Hospitals, healthcare providers, frontliners, and patients all benefit from clinical documentation education. Medical coding has become more complex, with new insurance requirements emerging every year. Experts agree that the key to accurate coding is proper documentation, which can be done when the personnel responsible for keeping records and assessment of data know what measures to take. Improved documentation is leading the way to getting patient information and coding while the patient is still in the hospital, which is contrary to the previous practice of coding the inpatient admission post-discharge.

Clinical documentation education teaches health providers and coders the methods for the precise reporting of diagnoses and procedures, facilitates a more effective communication pattern between coders and physicians, and fully integrates coders into the healthcare team, which can greatly improve the delivery of care. Ultimately, the hospital benefits from the advantages that diligent and proper recordkeeping brings. Medicare relies on proper documentation when performing assessment for reimbursements. Accurate recordkeeping, therefore, reduces compliance risks and minimizes the vulnerability of hospitals to denials during external audits. Accurate recordkeeping also produces documents that may be helpful in identifying problem areas in healthcare delivery. Major changes in healthcare policies can be overwhelming, especially for large hospitals and institutions that rely on coding and data analysis for proper delivery of healthcare services. Improvement of documentation procedures through physician documentation training can help in ICD-10 preparation and will make implementation of these new policies easier for all parties involved. Contact Provident Consulting for more information on clinical documentation education.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] (248) 957-0123 http://www.providentedge.com/

#icd-10 #clinical documentation education

Improve Reimbursements with Proper Medicare Management

As an insurance program, Medicare requires hospitals and medical service providers to provide the right amount of documentation in order to guarantee payment of services provided. This compliance requirement extends to billing rules and regulations as well as an understanding of new policies such as the Two-Midnight Rule. With the many policies, regulations, and new rulings regarding Medicare, hospitals and other health care institutions need to be well-versed in Medicare policies in order to comply with the program in order to avoid denials. Medicare Issues: Denial of Payments Denial of payments is one of the hot-button issues surrounding Medicare. Medicare has a number of denial codes that outline the reasons why payments may be denied, including:

skilled observation not reasonable and necessary

no physician certification

documentation not supporting homebound status

physician orders not signed in timely manner

insufficient documentation

Importance of Compliance with Medicare Regulations Although Medicare puts much emphasis on the provision of the necessary documentation, this alone does not guarantee that payment will be made. Many hospitals are currently unaware of new Medicare policies that could affect their chances of getting paid. A new policy, for example, requires additional documentation for patients admitted for two nights or more. Called the Two-Midnight Rule, this new policy requires doctors to submit a signed order with an attestation that patient is expected to be in the hospital for two or more nights, documentation explaining the medical reasons for such admission, documentation containing the estimated duration of the stay, and documentation of plans for post-hospital care. Collectively, these refer to physician certification of inpatient services. The stringent requirements that involve proper documentation and patient status audits arose, in part, due to Medicare's efforts to reduce the numbers of overpayments which have occurred in recent years – overpayments which have cost the government millions of dollars in revenue. Studies conducted by the RAC or the Medicare Recovery Contractors between 2003 to 2006 aimed to examine the extent of overpayments and identify instance of fraud, waste, and abuse of government-sponsored health spending by covered hospitals. They revealed that 85 percent of overpayments are attributed to inpatient hospital providers. A significant portion also covers audit errors that cover medically unnecessary services. More stringent requirements and a closer scrutiny of inpatient admissions by Medicare means that care managers need to ensure that they, the hospital, and its practitioners understand Medicare, what factors can reduce the chances of payment, and how well they can process appeals through an online appeals management program. A better understanding of Medicare requirements and regulations through improvement training for case managers can lessen instances when medical necessity for hospitalization cannot be justified. This includes ensuring that the level of care is appropriate and that coding must reflect the true nature of the case.

Get solutions for your reimbursement problems. Contact Provident Consulting today. Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172

(248) 957-0123 [email protected] http://www.providentedge.com/

#medicare

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