Unit 4 Continued
hmil_mUnit 4
2 Responses Needed
#1.
How can technology reduce error in medical coding while helping organizations remain compliant with billing and reimbursement?
Eradicating healthcare fraud and abuse became a top priority for the federal government. In fiscal year 1996 the federal government investigations were on the rise because 30% of all claims paid by the Health Care Financing Administration (HCFA) had errors. These errors accounted for $23.2 billion annually, or 14 % of total Medicaid fee-for-service payments. Almost half of the errors identified resulted from not enough information or lack of documentation from providers, and one third of the documentation errors were linked to Providers who failed to acknowledge repeated requests from auditors to submit documentation (Prophet & Hammen, n.d.).
Health Information Management plays a big role in both the clinical and financial appearance of healthcare providers performance. The integration of Electronic Medical Records (EMR’s) with documentation coding is required for effective patient care and reimbursement. Diagnosis Related Grouping (DRG) is a system by which hospitals and physicians diagnose cases into one of many hundred groupings. The only basis for DRG coding classification is the International Statistical Classification of Disease Related Health Problems (ICD). This system allows for a classification that identifies the services that hospitals provide and figures out how much commercial and Medicare insurers will pay the provider for each service.
Poor documentation can lead to either over coding, which carries some severe penalties, or under coding which can mean the difference between providing care that is profitable or providing care that is unprofitable (Health Information Management, August 2011).
References:
Prophett, S., & Hammen, C., (n.d.). Coding Compliance: Practical Strategies for Success. Retrieved from, http://library.ahima.org/doc?oid=58837
VRA Viewpoint – Health Information Management, (August 2011). Retrieved from http://www.vrpartners.com/viewpoints/health-information-management
#2.
Technology can help reduce billing and coding by keeping track of specific procedures being performed by providers. In most Electron Health Records systems a medical care provider will click through a series of screens before their documentation is complete for every click that is made another list is likely to be generated. This helps not only with compliance but keeping track of specific services that the provider is claiming they did but also remaining complaint with record keeping, which is required and a major part of reimbursement guidelines. In the matter of medical billing and coding one of the most important aspects is to know what is and what is not covered, which can be the job of technology to tell you so. For example, The Centers for Medicare and Medicaid services must know chief compliancy very well to know exactly what services can be billed for, how they can be billed and what will be covered. Having a staff that stays up to date on changing guideline in billing procedures is also vital to being complaint with billing and coding. Along with having a knowledgeable staff the staff should also have a great attention to detail especially if the medical facility is not equipped with a system that will correct errors or notify them of errors before the bill is submitted.
References Rumpakis, J. (2011). Coding and Billing Strategies for Advanced Diagnostic Technology. Review Of Optometry, 148(8), 46-53.
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