Avoiding and appealing CMS audits
Last April, Figliozzi & Company, Certified Public Accountants, was awarded a contract by CMS to perform audits of those Medicare providers, as well as dual-eligible Medicaid and Medicare providers, who have attested to meaningful use and have received incentive payments under the Medicare or Medicaid EHR (electronic health records) Incentive Program.
What is involved with a CMS audit?
All Eligible Professional (EPs) who are participants in meaningful use of electronic health records (EHR) are potential candidates for being audited. For the period beginning with 2011, the CMS has already started auditing selected practices, as well as conducting pre-payment audits for 2012. If the audit determines that the Meaningful Use requirement for even one of the measures has not been met, the entire payment must be repaid. There are as now no provisions for partial payments.
If targeted for an audit, it’s important to know that, at the time of this writing, your practice will have only two weeks to respond to and assemble the necessary documents. By keeping careful records submitted for attestation by the HER system, the EP can prepare for, and possibly appeal a negative finding that would require your practice to refund any incentive payments for meaningful use.
What information will you need to produce if audited?
Information currently being requested by Figliozzi & Company includes:
- A copy of technology system’s certification
- Supporting documents of the reporting methods used for reporting emergency admissions
- Supporting documents for attestation module responses pertaining to the core set of measures and objectives.
- Documents that support attestation module responses relating to the menu set of measures and objectives.
The CMS advises practices which may be targeted for an audit to keep all documentation that supports attestation. You should keep all post-attestation documents for a minimum of six years following the initial use.
What course of action should you take if you believe the audit decision was an error?
The CMS’s Office of Clinical Standards and Quality (OCSQ) offers EPs who disagree with the decision a two-tier way to appeal a finding. This consists of an informal review as well as a reconsideration request. As a rule, EPs can file an:
- Incentive Payment Appeal
- Eligibility Appeal
- Meaningful Use Appeal
- Eligible hospitals and CAHs filing for Incentive Payment Appeals are referred to a Provider Reimbursement Review Board for decision.
It is critical to file an appeal within the designated deadline – refer to the CMS appeal pages for specific updates on these. Appeals may be filed via email at: OCSQAppeals@provider-resources.com or by calling a toll-free hotline: 855-796-1515 from 9 a.m. to 5 p.m. Monday through Friday.
Extensions may be granted in limited extenuating circumstances; refer to the CMS Appeals PDF for more information.
Is it possible to simply avoid an audit?
While there is no guarantee that your practice will never be audited, there are ways to reduce the chances of this from happening. One of the best ways is to be sure your staff is fully trained and experienced in using the latest medical electronic health record (HER) technology as well as the codes and billing/ attestation procedures currently in place. M-Scribe Technologies , a leading medical billing and documentation company, offers experienced assistance to medical practices and clinics around the country with their documentation and billing needs.
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The deadline is fast approaching for implementing the new ICD-10 coding changes into your practice; if you haven’t already begun your staff’s ICD-training, here are some CMS-recommended steps for small to medium practices to follow to make the transition and training process go more smoothly. Developing a plan for the changeover to ICD-10 coding training can be done only after assessment, when you have a clear idea of what your staff’s needs are and have measured competencies and identified gaps in skills, to be able to focus on areas needing attention as well as which training approaches to use.
According to information from the CMS website, successful implementation includes:
- Understanding which implementation resources are available and where to best use them.
- Assessing staff training needs, including physicians, technicians, and nursing staff, as well as the billing and clerical departments. Part of this will include developing a budget for training, transitional assistance, and other resources.
- Developing a plan for training the parties affected.
- Managing staff productivity during the training and transitioning processes.
The CMS site offers several self- assessment questions that can help pinpoint areas of attention:
- First, who will receive the training, and what will it cover?
If this is a small practice, it’s especially important that all administrative and clinical staff receive training.
Coders and physicians will require more in-depth coding training for the new codes than a simple overview for administrative (receptionists or schedulers). Other clinical staff (such as nurses or physician assistants) should receive training on clinical details to improve documentation.
Documenting and updating patient charts, learning the new correct coding of administrative and medical records, updates in health information technologies, and health plans and contracts are some of the areas that will need to be addressed in future training.
- What are your staff’s current levels of competency in coding for medical procedures as well as anatomy?
By offering your coding and billing staff the chance to obtain certification in ICD-10 coding, you can help your staff reduce inaccuracies that may impede clean claims billing as well as increasing understanding of correct coding throughout the practice.
- What is the time frame needed for Implementation, including training?
Will you need to train your staff individually or as a group? Will there need to be any ‘downtime’ for staff built into training schedules? If so, how will you maintain an acceptable level of operation during training, and will this affect training schedules?
- What kind of training might work best for your practice and staff?
You might offer classroom training through an outside organization, or staff may prefer to use online training or other forms of self-study. Your transition team, under the guidance of your coordination manager, can advise you on what will work best for your practice.
- What will be the cost of the training?
This will be directly influenced by whether you choose to use classroom, online or self-study. Will your staff need to use any outside coding assistance to help cover daily administrative operations during the transition period once training is completed? If so, where will you obtain help and what will this cost?
- Once your staff’s ICD training is completed, what resources are available (manuals, online help or prompts, personal consultation, and so on) for resolving problems and questions as they arise in the course of transition?
M-Scribe Technologies is a national leader in medical billing and documentation for practices and clinics around the country. Their industry expertise can help your practice meet the ICD-10 coding requirements before, during and after implementation.
Join us for an ICD-10 Webinar that covers all the basics, talks about the advanced stuff minus the boring technical jargon and all this without burning a hole in your pocket. Yes, it's FREE!!
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As the manager of a medical practice or clinic that serves Medicare and/ or Medicaid patients, you need to be familiar with Meaningful Use, attestation and Electronic Health Records (EHR) certified technology to be compliant with the CMS’s Medicare and Medicaid Incentive program requirements. Failure to correctly follow the numerous criteria, such as core and menu measures, can result in failure to qualify for incentive payment, or an audit or demand for reimbursement of a previous incentive payment.
What is Meaningful Use?
‘Meaningful Use’ is a term describing the Eligible Professional (EP) or eligible hospital’s ‘meaningful use’ of certified EHR technology, as with electronic health records, designed for better patient care. It’s not sufficient to possess the technology – it must be in actual use. Meaningful use objectives include a ‘core set’ and a ‘menu set’ of objectives which apply to specific care providers or hospitals. For EPs, there are 24 objectives, of which 19 must be met to qualify for incentive payment.
There are 14 require core objectives, and 5 objectives selected from a menu list of 10 objectives.
In addition, there are also clinical quality measures that must be met to qualify for incentive payment.
What is meant by Attestation?
Attestation is the reporting (‘attesting’) by Medicare-Eligible Professionals and hospitals of their meaningful use of certified EHR technology, using a module developed by CMS for that purpose. (Medicaid EPs and hospitals will need to attest through their state Medicaid agency.) Attestation is by its nature a legal statement guaranteeing that the core as well as menu objectives have been met for payment.
How can you register on behalf of a care provider?
The CMS lets the Eligible Professional permit a third party (that’s you) to register as well as submit attestation documentation on the behalf of the EP. To do so, you will need to open an account with the Identity and Access Management System (I&A) with a User ID and Password, as well as be affiliated with that provider’s National Provider Identifier (NPI). Follow this link to open an account with I&A Security Check if you don’t currently have one.
Once you have made your request to CMS, you will be sent an email notice that the External user Services Help Desk has approved your request. The Eligible Professional must also log into I&A’s system and approve your request, once you have notified the EP of your request for access.
Note: With regard to Medicaid EPs, be sure to check with your state to ensure that you are familiar with what type of functionality is offered, as not all states offer the same functionality in Medicaid’s EHR Incentive Program.
Also, be aware that there is no automated email notification of I&A registration, so you will need to make a note of your Tracking Number.
For more detailed information, please refer to the CMS Medicare Registration User Guide (PDF) created by CMS to guide Eligible Professionals and other users through the registration process. Those practices participating in the CMS Medicaid EHR Incentive Program can refer to the PDF guide for EPs.
Where can you learn more?
The CMS website offers a wealth of information for practice managers and others who participate in the Medicare and Medicaid EHR Incentive Programs. There are specific guides for eligibility, registration and attestation requirements for both Medicare and Medicaid Eligible Professionals.
For assistance with your practice’s medical billing and documentation, M-Scribe Technologies, a leading national medical billing and documentation services company, can make your practice manager’s job easier by providing accurate compliance with cost reduction.
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Learning to use the ICD-10 is no simple task. To make the job a little easier, several healthcare industry stakeholders have joined together to create the general equivalence mapping (GEM) system which allows physicians, coders and other healthcare personnel a simpler way to understand which codes area available for which conditions.
The GEM system is designed to provide a bridge from the ICD-9 codes to the new ICD-10 codes in much the same way as a language dictionary helps you translate a word from one language into another. GEM aids coders in moving over to the new system, enabling them to become familiar with the ICD-10 options while relying temporarily on ICD-9 codes. In addition, GEMs allow coding professionals an opportunity to learn the differences between the code sets so they are able to make more informed choices when selecting the ICD-10 codes that most closely match their needs.
GEMs were designed to support all uses of coded data, and for ease of use, the system is bidirectional, which means it can be used to “translate” from ICD-9 to ICD-10 (forward mapping) and from ICD-10 to ICD-9 (backward mapping). This bidirectional features makes it easier for coding professionals to “check their work” and ensure the best possible match. Because the system is being used nationwide, GEMs also ensure consistency in coding use, especially during the initial period of transition. GEMs will also be available for three years beyond the initial compliance date.
Here are a few things you should know about the GEM system:
- GEM is not a one-to-one mapping between the ICD-9 and the ICD-10.
- Because the ICD-10 system comprises many more codes than the ICD-9 protocol, many ICD-9 codes will map to more than one ICD-10 code.
- In some cases, an ICD-9 code will not have a match.
- Likewise, some ICD-10 codes represent new concepts for which there is no ICD-9 code.
- More than one ICD-9 code may be needed to completely and correctly understand the ICD-10 correlative.
- Similarly, for any given ICD-10, there may be more than one possible ICD-9 translation.
To make coding more specific, there are separate sets of GEMs for reimbursement and for diagnosis. Both codes use the same general format and rely on two mappings: one from ICD-9 to ICD-10 and one from ICD-10 to ICD-9. To assist in selecting the correct code, especially when there are multiple codes available, the system also includes specific attributes that characterize the codes and further refine the choices.
When more than one code is offered as a possible match through the GEM system, it’s often because the ICD-10 system includes many more specific diagnoses and procedures than the ICD-9 system; therefore, using GEM all possible matches are offered.
In other cases, multiple codes may result when the classification system has changed under ICD-10; for instance, an obstetrics patient’s diagnosis classification would be made according to the episode of care under ICD-9; under ICD-10, obstetrics patients are classified by stage of pregnancy. In these cases, GEM provides specific rules for linking ICD-9 and ICD-10 codes.
Both the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) websites offer comprehensive and detailed users guides that feature information about how to use both the diagnostic and procedures GEM systems as well as examples of the system and its use. Users will also find a glossary defining terms specific to the GEM system and an appendix with file names and format information.
Transitioning to ICD-10 is both a time- and labor-intensive process. The GEM system is provided to assist healthcare providers in making the transition as easy as possible.
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How ICD-10 Affects Clinical Documentation
October 2014 is the deadline for implementation of ICD-10 coding standards. Preparing for the transition will be much easier when you take immediate action to improve your clinical documentation. The specificity level for the new code is much greater than that of ICD-10 and filling in the missing information will be a challenge. Major implementation issues will arise during changeover. Coding is a primary requirement of billing revenue. Being unprepared for ICD-10 documentation requirements can substantially impact your bottom line. Claims that are incomplete may preclude payment.
Under ICD-10 to assign a code: the following information will be required for code assignment.
- Laterality – Which side is related to the procedure or event
- Stages of healing – Includes whether healing progress is being made
- Trimester of pregnancy – First, second or third
- Episode of care – used to evaluate physician efficiency
How to prepare
Substantial changes in documentation are required to meet ICD-10 requirements. It’s imperative that documentation gaps be filled starting immediately. In addition physicians, coders and other relevant staff members must start training now if they haven’t begun already. Assessing the nature of missing documentation is essential. Assessment and training should be cyclic and ongoing processes.
Current documentation processes should also be assessed. Identify gaps that will need to be filled in order to ensure successful documentation under ICD-10. Next, initiate training to educate clinicians on ICD-10 documentation requirements a substantial amount of time prior to the transition so that they can have adequate time to prepare. Continue the process of assessing and training until documentation gaps are filled. Technological aids will help physicians comply with documentation requirements— Practice management systems can be configured to identify critical information missing from documentation and alert physicians to include additional detail.
Effects of Changes
Increased specificity of documentation for ICD-10 may entail significantly extra work, while challenging the way current clinical visits are documented, but it will ultimately promote patient care improvement. Collaborative insight and support for advanced research will result from ICD-10 implementation. More detailed, accurate and higher-quality data will lead to improved quality reporting, better clinical decision support and patient safety improvement.
Reimbursement for patient care will be faster with ICD-10. It will also be easier for medical coders to select the appropriate diagnostic codes because of the higher level of specificity. With greater detail fewer questions will be asked and payment difficulties will be reduced.
Documentation on Getting Ready
Medscape.org lists resources that can help on getting ready for ICD-10; providers are encouraged to take advantage of them. One such resource can be found at Centers for Medicare & Medicaid Services (CMS) ICD-10 website. It provides a comprehensive overview and includes free papers to help in implementation. There are also official codes and guideline for both small and large practices. You can use these to walk users through the process.
Training
The American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) offer formal training for coders. Train the trainer programs are also available.
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A recent study (May 2013) study published in the Journal of American Medical Informatics Association confirms the belief that the coming conversion to ICD-10 diagnosis and treatment coding is challenging to medical practitioners and other medical providers. Moving from ICD-9 codes to ICD-10 code sets and methodology is required and accommodates codes for newer diseases and treatment procedures.
ICD-10 Code Mapping
The final rule, published in August 2012, has delayed legal compliance until October 1, 2014. However the transition from around 14,000 codes to almost 69,000 codes is a major revision in the ICD-9 code sets medical personnel and billers have dealt with in the past.
While this conversion is required for all medical providers, this study confirms the prior warnings of challenges for all practitioners. The challenge goes beyond just the almost five-fold expansion in the raw number of codes necessary.
The World Health Organization (WHO), administrator of the codes, mandates diagnosis codes only. However, the US also supports codes for treatment procedures, adding to the volume of new codes. These additional codes serve to lengthen the potential learning curve for US insurance company and medical practice personnel.
The global medical community has already lobbied to change ICD-10 implementation dates, which have been extended twice to date. At this writing, it does not appear that another extension from WHO is forthcoming. Therefore, the October 2014 implementation date is firm, requiring practitioners and insurers to train and test now.
Study Results
University of Illinois-Chicago researchers conducted this study to learn the real world condition of the massive changes in code mapping in the transition from ICD-9 to ICD-10 coding. The new diseases that have appeared since the last code update only add to the conversion challenges.
Along with the cost of the conversion, the study found there is another "C" involved. Convolution. The research discovered the number of ICD-10 codes that respondents claimed were convoluted is significant. Study participants expressed confusion over the convolution factor.
The good news: Around 60 percent of ICD-9 codes directly translated to ICD-10 codes seamlessly. This should help experienced medical coders adjust to an apparent majority of conversion coding requirements. This still leaves 40 percent of new codes to be learned by personnel.
Unfortunately, the perceived convolution factor also reared up. Respondents noted that a full 36 percent of ICD-9 codes were convoluted, containing "entangled and non-reciprocal mappings." Even one percent of ICD-9 codes "had no corresponding code under ICD-10."
The study also indicates that some medical specialties will be highly challenged to enjoy a seamless conversion. Consider the following results.
- Around 60 percent of injury-related codes displayed convoluted mapping issues.
- Another 60 percent had equal convoluted code mapping confusion for obstetrics codes.
- Over 40 percent of infectious disease codes suffered the same convolution fate.
- Hematology escaped with only five percent code convolution, which hopefully helps this specialty make the transition successfully.
The cost issue goes beyond the budgetary effects of effective training, which may impact smaller medical practices more than larger practices and hospitals. However, the study also analyzed emergency department (ED) statistics from a cost and quality perspective.
Researchers found that up to 27 percent of ED encounters could be affected by the convoluted codes. This result troubled researchers, who believe that this result could "increase the risk of costly medical errors." The conclusion is not surprising.
Researchers recommend that all healthcare organizations target training and management efforts on ensuring the most frequently used codes and those identified as convoluted as a top priority. The extra cost of superior training could pale in comparison to the much higher potential cost of billing errors or incorrect diagnosis codes.
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No matter how carefully your records are managed, there’s always the risk you may find yourself in receipt of an overpayment decision issued by the RAC. Issued in the form of a repayment demand letter, there are specific steps you can take to appeal the decision if you think the RAC results are in error. There are a number of legal defense strategies that may be used in the RAC appeals process, so consulting with an attorney is a good first step.
If you decide to appeal an RAC audit, it’s worth noting that the RAC appeals process follows the same process as the process established for Medicare appeals. The five-level process detailed below can be time-consuming and for best results, you must be ready to provide adequate documentation to support your claim:
RAC Appeals Process
· First level: Also referred to as redetermination, these appeals are made to the Medicare Fiscal Intermediary or the initial processor. The first appeal must be filed within 120 days after receipt of the audit notification. At this level, any amount can be appealed. The appeal must include both From CMS 20027, a copy of the audit notice and an explanation detailing the basis for the appeal. The intermediary must respond within 60 days from receipt of the appeal.
· Second level: At this level, the appeal is made to a Qualified Independent Contractor (QIC). As with first level appeals, any amount may be appealed. Second level appeals must be filed within 180 days of receipt of the redetermination decision. Appeals may be filed using Form CMS-20033 or through written request and all supporting documentation, including the initial audit letter and the first level decision, should be included. Second level appeals are conducted on record without a hearing. In most cases, the QIC has 60 days to issue its decision; if the decision is not issued within 60 days, the provider may accelerate to the third level by filing with the Administrative Law Judge to initiate the third level of appeal.
· Third level: This level is available only for amounts of at least $140 and involves a hearing before an administrative law judge (ALJ). Requests for these appeals must be made within 60 days after receipt of the QIC decision and may be made using From CMS-20034 A/B. The hearing may be held via telephone or videoconferencing, or an off-record determination may be requested by the provider. In-person hearings are also available under special circumstances. ALJ decisions must be issued within 90 days of receipt of the request of a hearing, but that deadline may be extended in certain cases. When the deadline is exceeded and no compelling reason is given, or if the provider disagrees with the decision, the provider may move to the fourth level of appeals.
· Fourth level: Requests for these appeals must be made within 60 days of receipt of the decision by the ALJ and are made with the Medicare Appeals Council (MAC) using Form DAB-10. The decision of the MAC must be issued within 90 days of receipt of the provider’s request, but again, the timeframe may be extended due to special circumstances. When the timeframe is exceeded or if the provider disagrees with the decision, a fifth – and final – level appeal may be filed.
· Fifth level: These appeals are made via a judicial review in a federal district court and are only available when the total being disputed is at least $1,400. Requests for fifth level appeals must be made within 60 days of receipt of the decision issued by the MAC. Unlike the other levels, there is no timeframe by which fifth level determinations must be made.
At all levels of appeal, timing is critical, and when taken through the fifth level of appeal, the entire process may take as long as two years. Appeals forms may be downloaded via the CMS website, but before you being the appeals process, be sure to consult with your attorney to understand all your defense options.
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Background
There has been an abundance of improper Medicare and Medicaid payments made. Recovery Audit Contractors (RAC) are retained by the US Government to identify any under payments or overpayments made to health care providers. Another responsibility they have is to make payment adjustments in order to correct identified errors.
In 2007 nearly $11 billion improper Medicare payments were reported. In addition many Medicare claims were non-compliant in terms of billing, coverage, coding or payment rules. Because of the huge number of inconsistencies, the US Congress created the RAC program. RAC contractors receive an initial fixed payment for each occurrence of improper payment. In addition they receive a percentage of recovered funds. Not surprisingly, the AMA likens RAC to bounty hunters and deeply disapproves of this organization.
RAC will not review claims reviewed by other entities. 4 regions have been created covering the US and each has one RAC contractor.
How Do Mistakes Happen?
According to the American College of Emergency Physicians overpayments can occur when health care providers submit claims that fail to meet coding or medical policies. Underpayments can occur as well. These happen when health care providers submit claims for a simple procedure when the actual procedure that was performed was more complex. Types of providers eligible for review include any facility that submits Medicare claims. Included are physicians, hospitals, nursing homes, medical equipment suppliers and home health agencies.
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How Far Back Can a Medicare RAC Audit Go? The initial Medicare look back audit period was four years, but vehement objection from the AMA reduced this period to 3 years.
Expansion of RAC and Hospitals
Compliance Knowledgebase makes some recommendations regarding updates in hospital procedure in light of RAC expansion. At the close of 2010 the RAC Program was expanded to include Medicare and Medicaid parts C and D. To be able to pass a look back audit hospitals should have a RAC team in place. This team should monitor relevant websites periodically for updates. Hospitals should also have a process for RAC appeals. Creating a central location for medical requests is advisable as well.
RAC Truth Vs. Fiction
CMS provides the following RAC Audit myths you should know about the RAC audit program.
- RAC always denies all claims.
- Every RAC denial is overturned when appealed.
- RACs do not notify organizations about what they are reviewing.
- RACs outsource medical review work to staff in India and the Philippines
Factors that are significant in terms of review are:
- Available documentation
- Medical necessity
- Correctness of coding overpayment
- Correctness of coding underpayment
- Other
CMS Medicare RAC Appeals Process
Physicians can appeal a RAC determination by following the appeals process documented below.
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Medicare RAC Appeal Level
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Days to Submit Appeal
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Claim Reviewer
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1. Redetermination
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120
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Medicare Administrative Contractor (MAC), carrier, or Fiscal Intermediary (FI)
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2. Reconsideration
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180
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Qualified Independent Contractor (QIC)
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3. Administrative Law Judge (ALJ) hearing
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60
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ALJ
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4. Medicare Appeals Council review
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60
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The Appeals Council is within HHS
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5. U.S. District Court
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60
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U.S. District court judge
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What Are RAC Program Benefits?
The RAC program greatly enhances the accuracy of Medicare and Medicaid reporting. It makes sense for work done under government programs and guidelines to be audited for accuracy. This program has already reaped many tangible results. AHA.org indicates that in May 1, 2012 nationwide audit statistics showed a substantial 33% in overpayments.
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The number of medical billing errors that occur each year in the United States is alarming: According to an article in the Wall Street Journal, anywhere from 30% to a whopping 80% of medical bills may contain errors, and the number of practices experiencing errors in their own billing processes is expected to climb as more and more of them implement their own in-practice EHR programs and fail to thoroughly train their staff in system use. There are many reasons why claims may be rejected, but no matter the reason, billing errors can be costly both to patients and medical practices. Not only can errors delay payment, but they can also raise red flags that can result in an RAC audit.
Here are five tips to help ensure your medical billing process is accurate:
1. Verify insurance benefits. The lion’s share of errors could be avoided if providers would take this critical step each time a patient receives services. Especially when a patient returns on a regular basis, it can be tempting to use information that was recently entered; the patient’s insurance company have changed, terms of service may have changed or the policy limit may have been reached. For each patient – returning and new – it’s imperative to check with the insurer to confirm coverage dates and allowed benefits, as well as co-payments, the need for authorizations and other pertinent information that can affect your billing or result in an error.
2. Verify patient information. Even small errors in a patient’s name, birthdate or gender can result in a claim being denied. If the patient isn’t the primary policyholder, the relationship to the policyholder should be checked for accuracy, as well as policy and group number when required.
3. Check – and then re-check – diagnosis and procedure codes. Using the wrong diagnosis or procedure code can cause the claim to be rejected because the insurer believes, based on the incorrect code, there is a lack of medical necessity or the procedure performed does not match the authorization received. Make sure your office staff is using the most recent coding books and that all billing staff are properly trained in the coding process. Providing ongoing training and purchasing new editions of coding books as they are released may seem costly, but taking these steps can avoid much more costly errors in the future.
4. Write clearly – or implement an EHR system. It may be an old joke that physicians’ handwriting is pretty bad, but the joke stops being funny when claims are rejected due to poor penmanship. If the physician resists cleaning up his or her act, billing staff should be trained to question any codes that seem inaccurate or hard to read. Another option: Use an automated system for billing, but be sure your staff is properly trained in its use. Poor training is the leading cause of EHR billing errors.
5. Make sure you haven’t already billed for the service. Chart audits are an effective way to make sure bills are not submitted twice. In some cases, bills may erroneously be submitted for procedures or tests that have been cancelled or rescheduled. Chart audits also can usually catch these errors as well.
Proper training and extra care and attention by billing staff are the most effective ways to eliminate medical billing errors. Take the time to implement quality-control policies and programs and make sure your staff understands the steps they need to take to keep your practice’s billing and coding procedures as error-free as possible.
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For those looking for top ICD-10 educational resources for in preparation for the October 1, 2014 coding changeover, this guide may help. Practitioners as well as medical billing and coding services must have the updated coding training before October 1, 2014, when it is scheduled to go into effect.
What are the ICD-10 changes?
The older ICD-9 Codes have been updated to reflect the advances in healthcare that have impacted the code sets used for reporting medical diagnoses and procedures. These changes will affect everything from provider contracts, software and billing systems, changes in vendor relations, budgeting and training issues and organizing the entire implementation process from top to bottom in your office or department.
ICD-10 training and other resources
Here are some of the best– including several, such as AHIMA, that offer courses designed to train your office’s trainers:
AHIMA – The American Health Information Management Association’s website is one of the main go-to places for anyone who is involved in medical billing, records management, and related health information support. AHIMA not can only help you with obtaining training and certification but offers a list of top ICD-10 seminars and workshops around the country that will get you or your staff up to speed on the latest updates and advances in your industry.
Among the ICD-10 online and in-person training and other workshops and course offerings through AHIMA are:
- ICD-10 Overview and readiness assessments
- Training pathways tailored to your role and setting, including home health, LTC, and physician practice
- Training for non-coding personnel involved in the transitioning
AAPC – Founded in 1988 to provide both training and certification for physician-office medical coders, the American Association of Professional Coders now offers a full spectrum of educational and credentialing resources including training in auditing, compliance, and practice management.
Their courses for ICD-10 training include online, a two-day ‘Boot Camp’ taught in a group setting in locations around the country, as well as on-site training.
Boot Camp courses include:
- Introduction to ICD-10 Coding
- Hands-on Coding Exercises
- Organizing the Implementation Plan
CMS – The Centers for Medicare and Medicaid Services government website offers a wealth of official free resources for provides, payers and vendors looking for help with Medicare and Medicaid ICD-10 implementation timelines and planning as well as updates on the latest regulations, and other information. Some of the resources available include:
- ICD-10 fact sheet and FAQ pages
- Tips to ensure a smooth transition to the new coding
Other recommended sites for ICD-10 educational resources are:
HIMSS – Healthcare Information and Management Systems, an organization for health information professionals, offers a PlayBook page on its website with information about transitioning to ICD-10 for practitioners, hospitals, clinics and staff. Topics include:
- Planning and Implementation Advice
- An ICD-10 Financial Risk Calculator tool
- Vendor Readiness
WHO – World Health Organization – offers full ICD-10 training modules with Interactive Self learning tools on their website.
Medscape – As an online medical information and education website, they offer several resources for ICD-10 education and implementation for clinicians, group practices and other health-provider organizations. The site is free to join and offers regular updates on timely medical topics and education opportunities.
WEDI – The Workgroup for Electronic Data Interchange has information about various vendors offering education and other resources for ICD-10 coding.
Elsevier – Healthcare publisher Elsevier offers online ICD-10 training modules and manuals, prepared by leading coding educators.
ICD-10-CM Code Lookup and Translation - Physician-created free website with ICD-19-CM and PCS codes, conversion tool and other information.
Medical practices needing help with ICD-10 transitioning may contact M-Scribe for expert assessments and implementation strategies tailored for your practice.
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For more information about M-Scribe Billing Services please contact 888-727-4234.