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Tag Archives: After

Providers see only minor productivity declines after ICD-10 implementation, according to survey

 By Steven Andrews

A decrease in staff productivity has been the top challenge for providers after ICD-10 was implemented, but relatively few organizations have seen a significant decrease in productivity, according to a recent survey from Navicure.
Despite nearly half of the participants (48%) noting a productivity decline as the top issue, only 13% of administrative staff and 15% of clinical staff saw a significant decrease. Another 46% of administrative staff and 42% of clinical staff didn’t see much of an impact, and the remaining respondents saw a minor impact or didn’t know of one.
The survey included 360 participants representing a broad range of specialties and sizes, with 60% from organizations with one to 10 providers.
Beyond productivity, 20% of respondents said revenue disruption was their top concern. However, 60% of organizations did not see any impact on monthly revenue following the transition. In terms of denial rates, 89% of respondents saw either no change or an increase of less than 10%.
All of these statistics are overwhelmingly positive for the industry, which was subject to constant fear mongering from organizations such as the AMA in the months before the transition, with predictions of massive productivity declines leading to insurmountable revenue problems for countless providers.
Predictions about how much providers would spend to get ready for implementation varied widely, depending on the source. An AMA-funded report from Nachimson Advisors estimated small physician practices would spend approximately $ 57,000-$ 200,000 to get ready. Even though this was already questioned, the actual results from the survey show a much different story.
Half of the respondents spent less than $ 10,000 on training and software updates, with another 14% spending between $ 10,000-$ 50,000. Only 5% spent more than $ 50,000, while 20% weren’t sure how much their organization spent.
And organizations are confident they’re coding correctly. Nearly all of the respondents (99%) reported sending the most specific ICD-10 code either all of the time or sometimes.
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Your current subscription to APCs Insider will be transferred to the Revenue Cycle Daily Advisor. The last issue of the APCs Insider is scheduled for today, January 22. Please watch for your issue of Revenue Cycle Daily Advisor starting next Monday, January 25. – APCs Insider

Physician Orders for Lab, Radiology Services, and Other Services after ICD-10 Implementation

CMS is not requiring the ordering provider to rewrite the original order with the appropriate ICD-10 code for lab, radiology services, or any other services after ICD-10 implementation on October 1, 2015, including Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

Products and services that require a diagnosis code on the order will use ICD-9-CM codes if written prior to October 1, 2015. If the order is for a repetitive service that will continue to be delivered and billed after October 1, 2015, providers have the option to use the General Equivalence Mappings (GEMs) posted on the 2016 ICD-10-CM and GEMs web page to translate the ICD-9-CM codes on the original order into ICD-10-CM diagnosis codes.

Coding Ahead

What is a Medical Coding and Billing Career Like After Schooling is Complete?



Finishing the requirements for a certificate or associate degree in medical coding and billing is only the beginning. Now’s the time to begin applying for positions and testing your skills. Your job search likely won’t be long because the demand for medical coders and billers is high. The Bureau of Labor Statistics reports that employment in the health informatics field will grow faster-than-average by 15 percent through 2024. Healthcare providers can’t be reimbursed and remain profitable without medical coding and billing specialists. Here’s what this in-demand job will entail after graduation.

Daily Responsibilities

Medical coders and billers oversee crucial steps in the reimbursement process to keep the revenue cycle flowing. Medical coding specialists will carefully review patient files in the electronic health record system. By following the doctor’s notes, they’re able to assign numerical codes to the diagnosis and treatment provided. Coders flip through resource books to determine the right CPT or ICD-10 codes for each patient service. Every cost, including lab tests, consults, medications, and treatments, gets coded. Medical coding specialists often talk with physicians or nurses to clarify any unclear patient information.

For medical billing jobs, the daily duties will differ. Medical billers collect the records that have been coded to turn treatments into invoices. They assign financial values to patient services and submit insurance claims to the proper carrier. Billing specialists interact with the insurance company’s representatives to get claims processed. If coverage isn’t available, medical billers will send out bills to patients and follow up until they’re paid. When claims are denied, they also spearhead the appeals process on behalf of patients. Some medical billing specialists assume basic accounting roles by drafting accounts receivable reports.

Typical Work Environment

Medical coders and billers work behind the scenes in office cubicles for healthcare organizations. Most of their day is spent sitting at a desk, typing on the computer, and speaking on the phone. The desks of medical coding and billing specialists are often stacked with reference materials, claims forms, and patient files. They work independently because paying attention to detail is essential for accuracy. Direct patient contact isn’t common unless they must answer invoice questions from an uninsured individual. Medical coding and billing jobs are usually full-time with normal 40-hour weeks from nine to five, but part-time scheduling is offered too.

Virtually all healthcare organizations depend on a medical coding and billing team. The majority, around 38 percent, are employed in state and private hospital systems. Medical coders and billers also work in physician offices, outpatient centers, clinics, specialty hospitals, rehabilitation facilities, and managed care organizations. Others work on the opposite side of the claims process for health insurance companies. Experienced coders could work for government agencies like the Department of Health and Human Services (HHS). Although it’s important to beware scams, some medical billing and coding jobs are remote for working from home.

Career Advancement

Since medical codes and insurance laws continually change, schooling never really stops in this profession. Becoming certified is the best way to advance your career. The American Academy of Professional Coders offers the industry’s certifications. The Certified Professional Coder (CPC) credential is available to those with two years of coding experience and 36 continuing education units. There’s also the Certified Professional Biller (CPB) and Certified Risk Adjustment Coder (CRC) designations. Experience can lead to advancement in other avenues too. Coders can eventually become medical records technicians, coding managers, clinical data analysts, and health information directors.

Building a career in medical coding and billing provides many benefits without a long trek into higher education. Graduates of online or on-campus training programs will utilize state-of-the-art software technology to coordinate patient payments. The career path offers an average yearly salary of $ 40,430, or $ 19.44 per hour, with room for advancement. Medical coding and billing jobs place workers at the helm of keeping healthcare systems profitable and cost-effective.

Top Medical Coding Schools

HHS Fugitive Captured After 20 Years on the Run – April 2016

Captured HHS Fugitive


Did you know that the HHS inspector general’s office has a “most wanted health care fugitives” list? It is publicly listed on the OIG website where they are seeking more than 170 fugitives on charges related to health care fraud and abuse. 
This month, a fugitive that has been on the run for over 20 years was finally caught and arrested. 

Robert Allen Lopez, who pleaded guilty to Medicare fraud on December 14, 1995, was arrested April 2016, at Miami International Airport. He is in custody and will face additional federal charges. Lopez fled the country after pleading guilty but before his sentencing hearing.

According to the indictment, from July 1991 until June 1994, Lopez and others conspired to defraud Medicare by filing false claims and structuring cash transactions to evade federal currency-reporting requirements. The fake claims totaled more than $ 4 million. OIG investigators found that Lopez established numerous companies in Miami, using sham owners to conceal that he was the true owner. These companies filed false Medicare claims on behalf of beneficiaries for services that were either medically unnecessary or were not provided.

Lopez also recruited friends and relatives to assist him as sham owners, according to the indictment. He directed them to open bank accounts where the fraudulently obtained Medicare reimbursements were deposited. To avoid reporting requirements for cash transactions exceeding $ 10,000, it is believed that Lopez directed the sham owners to make structured cash withdrawals from the accounts. When Lopez violated his bail agreement and left the country, he fled with his two children without his wife’s consent. His 10-year-old son was found four years later wandering the streets of Cancun, Mexico. The child was taken into protective custody and reunited with his mother in the United States.

Lopez was captured after OIG agents, together with the State Department Diplomatic Security Service (DDSS), got a tip that he was living under a false name in Nicaragua.
Agents from DDSS and the U.S. Marshals Service worked with the Nicaraguan government to apprehend Lopez and arrange his return to the United States


Additional Resources

Full list of captured HHS fugitives

Full list of HHS fugitives (wanted & captured)

The Medical Management Institute – MMI – Medical Coding News & MMI Updates