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Tag Archives: chart

Concern Raised Over Estimated Billions Shown in Chart Reviews

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The Office of the Inspector General of the United States undertook a recent study in which they reviewed a myriad of Medicare Advantage organizations (MAOs). There were concerns that these MAOs may be using chart reviews to increase the intake of their risk adjusted payments in an inappropriate manner. To those not in the know, unsupported risk adjusted payments are a major factor behind improper payments in the Medicare Advantage program (MA for short). In 2018 alone, the MA coverage to 20 million beneficiaries to the tune of $ 210 billion.

Click Here to Read the OIGs Full Study!

The post Concern Raised Over Estimated Billions Shown in Chart Reviews appeared first on The Coding Network.

The Coding Network

Can someone review chart note to see if I’m on the right track?

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Hello again, colleagues,
After receiving helpful advice from a fellow member, have come across another scenario that is baffling due to my limited experience in this type of coding.

PRE-OP DX: ischemic ULCER RIGHT LATERAL FOOT
post-op dx: osteomyelitis WITH ISCHEMIC ULCERATION OF RIGHT LATERAL FOOT INVOLVING 4TH AND 5TH METATARSAL AND CUBOID BON

Performed:
1) debridement of right foot to include skin & soft tissue and cuboid bone right foot.
2)Right 5th metatarsal resection, partial
3) right 4th metatarsal resection, partial

Description: (extraction of pertinent verbiage). Ischemic ulceration was then debrided over the lateral foot. This clearly involve the 5th metartarsal bone.
Wound did extend more medially w/involvement of the cuboid bone as well as the 4th metatarsal. These were all sharply debrided back with a rongeur and
the 5th metatarsal was resected along with a portion of the 4th metatarsal. Would was packed w/saline-good bleeding was appreciated from wound bed.

My efforts: I see a debridement here in #1, but not sure about the two codes for #2 and #3. I’m thinking 28122, 28122. (The 5th metatarsal was resected, with a portion
of 4th?), so not sure about choosing the same code for both procedures when one was a partial.

Can anyone offer guidance?

Medical Billing and Coding Forum

echo document vs chart diag.

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Please help
I’m told by my billing manager to change the unspecified ICD-10 code on 93306-26 echo to a specified code listed in the consult/visit in the chart. I always thought the diagnosis must be specified in the echo documentation report and echo should have the capability to stand alone.
is she correct?
Thanks

Medical Billing and Coding Forum

Risk Adjustment Chart Review

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We are a solo practitioner but sees patients with heart problems and other co morbidities.

Bec we are in a rural area and not a lot of specialists here, we see a lot of complex patients. We are getting swamped with request for records from insurances, like 120 from BCBS, 80 from Humana, 50 from Aetna, etc.

We are drowning and had to pull resources to be able to comply with this requests.

I understand that it is in the contract that we should pull the records as requested but i think it’s unfair that the insurances are getting money from the government, and we are doing all the work.

Any thoughts?

Medical Billing and Coding Forum

Experience Revenue Cycle and Medical Chart Auditor

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I have 25 years’ experience in Medical billing with advanced knowledge in Federally Qualified Health Centers, Private Practice Management and Rural Healthcare. Upon arrival at Operation Samahan, Inc I discovered the organization was still using the 2014 Medicare PPS rate, this was updated. Then rebuilt the billing department, created and sent statements and collection letters for the first time in the history of the organization. Also, the organization was in debt to the State of California for $ 8.5M, and additional amount of $ 2.5M to be added for the FY17, I improved billing and reconciliation so that for the FY17 reconciliation with the State of California came to approximately $ 150K. Corrected the uploading of file for a Capitated plan, as OSI was not receiving capitation payments. While for a short period of time I over saw the call center, I implemented automated call reminders. Created a sliding fee discount tracking, reduced AR days from 106 to 30 and retrained all front desk and MA’s on registration. Cleaned the system up to reflect true A/R
Attached Files

Medical Billing and Coding Forum