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Novitas Solutions issued a reminder March 10 about billing for temporary implantable female urological prostheses, reported with CPT® codes 0596T and 0597T. If your claims for these services are being denied, it’s no wonder, what with all the policy changes in recent years. The service coding isn’t the problem; it’s the device coding. Coding Insertion […]
The post Coding InFlow Device? Check Date of Service appeared first on AAPC Knowledge Center.
Other claims system glitches fixed, with one still waiting. The Centers for Medicare & Medicaid Services (CMS) continues to issue new rules to accommodate no-pay Request for Anticipated Payments (RAPs) and Patient-Driven Groupings Model (PDGM). Principal Diagnosis CMS has reissued Change Request (CR) 11855 and added a few new instructions about requests for anticipated payments. […]
The post RAP Diagnosis Code, Service Date Instructions Change appeared first on AAPC Knowledge Center.
A troubling trend in the medical coding industry is a misleading split model where companies will have resources both onshore and abroad but not disclose which personnel are performing the services. Some use their domestic resources almost exclusively for client facing interactions, such as sales and operations, but send all of the coding work to be performed offshore to reduce their costs. This creates the illusion of a US based workforce, but it comes with the dangers of offshore medical coding.
The dangers of offshoring coding work are twofold: 1) accuracy, and 2) privacy. Coding is a highly specialized cognitive function that cannot be commodified. This isn’t bandages or simple repetitive tasks. It is a service that requires a great deal of specialized knowledge and critical thinking that takes years of practice to hone and constant education to ensure that the coder is kept abreast of updates to their field. As an external auditing provider, The Coding Network has audited a bevy of offshore coding vendors. Our overwhelming experience is that offshore coding is suboptimal and greatly concerning for organizations that utilize their services.
Additionally, there are no HIPAA laws outside of the United States, raising privacy and security concerns. A vendor might assure their clients that their overseas facility is secured, but if there is a breach of an organization’s PHI the only mechanism to protect themselves against the vendor would be a contractual claim, i.e. a breach of the terms of a BAA, not an enforcement action. Trying to sue an entity that maintains most of its operations and assets offshore makes any recovery incredibly difficult and the likelihood of recompense murky at best. You wouldn’t even know your information is leaked until it ends up in the wrong hands and since it would be impossible to trace without a candid engagement by the vendor, there is little that could be done.
Remember that the PHI in question is that of an organization’s patients. What would the patients think if they discovered their personal information was being sent abroad for no other reason than to save the organization money. This cost savings to an organization is nominal and more often than not the patients do not realize any of the savings in their billings. From a public relations standpoint, this will likely not go over well with a practice’s patient base and could result in a loss of business and/or reputational harm.
Whenever dealing with a coding vendor it is important to make sure they are doing the work in the USA. One tip is to ask for a clause in your contract that requires US-based coding. Additionally, look out for pricing that seems too good to be true. If you’re paying a bargain basement price for your coding work you will be getting bargain basement quality and security.
The post Split Model Service Providers (Medical Coding Vendors with Offshore and Onshore Operations) appeared first on The Coding Network.
Collaboration and auditing are important to the health of your organization. The objective of a value proposition is to create products and services that customers want that also benefit the organization. The auditing department at Duke University Health System (Duke) recently built a value proposition based on concepts outlined in the book Value Proposition Design: […]
The post Design a Value Proposition to Improve Customer Service appeared first on AAPC Knowledge Center.
Got an e-mail from a provider nurse this morning asking:
"Can you perform (and be paid) for balance testing the same day a patient is discharged from the hospital? I know we cannot get reimbursed for outpatient procedures/exams performed while they are inpatient?"
Thoughts?
CMS’ latest guidance reiteration will, hopefully, make coding these sometimes-confusing services easier. Determining the date of service (DOS) when reporting a medical claim seems straightforward, but the Centers for Medicare & Medicaid Services (CMS) recently-released “Guidance on Coding and Billing Date of Service on Professional Claims,” is a good indication this topic is more complex […]
The post Refresh Your Understanding of Date of Service Requirements appeared first on AAPC Knowledge Center.
Thanks!
The Lee County Fiscal Court (“Lee County”) and the previous executive of its emergency vehicle administration, Joseph Broadwell, have consented to determine common charges that Lee County Ambulance abused the False Claims Act, a bureaucratic law that disallows the accommodation of false or deceitful cases, consenting to pay $ 253,930 to the national government.
The post Lee County Ambulance Service and its Director Agree to Pay $ 253,930 to Resolve Allegations of False Claims to Medicare appeared first on The Coding Network.