Get It Right the First Time

Recently a friend mentioned some advice he often heard as a boy.  His dad would say if you have time to do it wrong and then do it over, you could have done it right the first time.   When it comes to coding and claims filing, perhaps we could learn from this father’s advice to his son.

Did you know that for just a few bucks per claim, you could be practicing medicine in Florida and have an AAPC coder certified in your specialty do your coding remotely from an office in Ohio?  Or Colorado, or Arizona?   It’s so easy and convenient in this technological age!

Remote Coding Protects You

Why do I mention this?   More and more physicians are looking for ways to maximize their earnings and protect themselves from future recoupments.  In this world of RAC Audits, MIC Audits, ZPIC, the OIG, and continual tightening of compliance requirements, wouldn’t it be great to know that at least your claims are being coded correctly and won’t trigger an audit?

Having your coding done by a certified coder reduces your exposure to the highly sophisticated data-mining software that is being used to audit hospitals now and will be used to examine your claims in the future.

Remote Coding Makes You Money

Did you say makes me money?   Yes, absolutely it does!   If you have thought of outsourcing your coding as just another expense, think again.   It’s a proven fact that certified coders pay for themselves several times over by maximizing claim reimbursements while minimizing claim rejections.  A certified coder will also help you as a physician improve your documentation and compliance, again resulting in more income for you.

Remote Coding Cuts Expenses

Outsourcing your coding eliminates the vulnerability that comes from depending on employees. Never again get “surprised” when your in-house coder is out sick, gets pregnant, or leaves for another job offer.   You can reduce staff or better yet, free her up to work with patients as your practice grows.

I am fortunate to have access to around 250 AAPC certified coders.  If you send me an e-mail, I can put you in touch with one in your specialty.

Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics.  He serves as President of National Business Solutions of GA, LLC.  He can be reached at winston@nbsoga.com for questions or comments

The CMS Inadequate Process

At the end of last month, the US Government Accountability Office (GAO) released a 52 page report detailing what it sees as a failure by the CMS to establish an adequate process to:

address RAC-identified vulnerabilities that led to improper payments, such as paying duplicate claims for the same service.

Additionally the:

CMS has not yet implemented corrective actions for 60 percent of the most significant RAC-identified vulnerabilities that led to improper payments…

Finally:

CMS did not address significant vulnerabilities representing $231 million in overpayments identified by the RACs during the demonstration project. For the RAC national program, CMS developed a process to compile identified vulnerabilities and recommend actions to prevent improper payments. However, this corrective action process lacks certain essential procedures and staff with the authority to ensure that these vulnerabilities are resolved promptly and adequately to prevent further improper payments.

What does this mean to you?

Certainly, it appears the CMS plans to operate “business as usual”.

No fixes to the broken system, only the heavy hand of the RACs to swoop in, make the physicians life miserable by creating more overhead in processes and the ever-constant fear of a RAC knocking on the door and wanting money.

As none of this will get fixed in the foreseeable future, you need to cover back-side by ensuring your staff is properly trained in all aspects of medical coding.