GREENWOOD, Ind., Jan. 10, 2017 /PRNewswire/ — Medical code verification services provider AmeriVeri (http://www.ameriveri.com) adamantly supports the move to value-based payment (VBP) programs for government and commercial payers. Already well underway throughout the industry, this sea change in how payments are calculated will lead to superior patient care and more precise data for EHRs, providers, healthcare policymakers and researchers. And with the help of AmeriVeri’s proprietary verification process, third party administrators (TPAs) and insurance companies can ensure that VBP programs deliver on their promise to reduce skyrocketing healthcare costs.
“The twin pillars of a well-conceived and effective VBP program are precise documentation and coding proficiency,” says AmeriVeri Director of Claims Management Steffeny Brewer. “Our purpose is to maximize that precision, saving money for payers and enabling providers and provider networks focus on achieving quality benchmarks.”
Value-based payment (VBP) programs utilize documented and coded patient outcomes to decide whether a patient was provided quality care. The top three reasons for inaccurate claims payment can be attributed to insufficient documentation, medically unnecessary services, and incorrect diagnosis coding. The proprietary service developed by AmeriVeri detects medical coding errors routinely missed by every other adjudication process.
On average, AmeriVeri identifies two to six errors per every 100 lines on medical claims. In their experience, Healthcare facilities and providers want and need to achieve accurate claim reporting, as clean claim reporting directly impacts their payment for services rendered. In between those twin goals exists the opportunities to (1) create massive healthcare savings, and (2) help assure the accuracy of medical records. The easiest, most efficient, least expensive method to achieve those goals is to utilize AmeriVeri’s proprietary process. Set up takes minutes, and turn-around time is one hour or less.
Value-based payment is a fundamentally different way of reimbursing medical claims; it rewards providers for achieving superior outcomes, and in many cases, penalizes them for complications and re-admittances. On the other hand, the fee-for-services model, which has long been the standard, looks only at volume. In other words, fee-for-services pays for inputs, while VBP pays for outputs. While this payment model can take many forms, they share the essential goals of improving care and trimming costs.
An estimated 30% of all healthcare dollars are wasted. A major emphasis of VBP is to reduce that number and slow the rapid inflation of healthcare costs. AmeriVeri shares that mission; its proprietary medical code verification process already has the capacity to save the country $6.5 billion annually in healthcare costs.
The Deficit Reduction Act of 2005 introduced the first VBP program, and the Center for Medicare and Medicaid Services rolled out a version (Hospital VBP) in 2009. Since then, the Affordable Care Act has made that program permanent. Commercial insurance companies have been quick to follow the lead of government payers. Both Anthem and UnitedHealthcare have steadily increased their commitment to numerous VBP programs. Reimbursement programs tied to value rather than volume will shortly become the standard model. The Department of Health and Human Services has set an ambitious goal for 90% of Medicare claims to be value-based by 2018. Meanwhile, the CMS reports that it’s ahead of schedule on its own goals for transition.
Making the move toward VBP programs possible has been the rollout of ICD-10 diagnostic codes. This new set of codes allows for more specificity in diagnosis, condition severity and outcomes – data points that are essential in determining reimbursement level. Industry analysts have rightly observed that providers should be embracing ICD-10 sooner rather than later.
AmeriVeri functions as a unique additional filter to assure payers that codes are effort-free. What distinguishes the service from other adjudication software is its focus on “medical necessity” — AmeriVeri’s code verification can detect when procedure and diagnosis codes do not make a logical pairing, and kick the claim back to the provider for editing and resubmittal. The service routinely identifies two to six errors for every 100 claim lines. Just as importantly, AmeriVeri safeguards the accuracy of patients’ medical records, which contributes to long-term quality of care.
The simultaneous shift toward VBP and ICD-10 is no small challenge for many providers, especially those responsible for their own coding. Billing companies, too, must make big adjustments to accommodate this new paradigm. AmeriVeri is well positioned to help this transition as smooth as possible.
About AmeriVeri CR, LLC
AmeriVeri offices are located in Greenwood, IN, and Denver, CO, with affiliates in Chicago, Minneapolis, St. Louis, Columbus, Cincinnati, Atlanta, and Dallas, providing nationwide enhanced medical code verification services in the Major Medical, Workers’ Comp and Medicaid arenas. Implementing AmeriVeri’s code verification service is fast and seamless with no new software to install, and a one hour turnaround time. AmeriVeri maintains a 100% client retention record.
GREENWOOD, Ind., April 4, 2016 — PR Newswire — AmeriVeri (http://www.ameriveri.com/) helps protect the integrity of Medical Records and saves patients from unnecessary, costly and possibly dangerous treatments resulting from medical coding errors. What many don’t realize is how shockingly common these errors are.
Real-life examples of how coding errors affect lives include the denial by John Alden of a health insurance policy because of a single coding error in the applicant’s permanent medical record. The applicant had to enlist both the original and a supporting physician to review and correct the error. During that time, the individual went without health insurance – a risky proposition.
In another case, a commercial pilot was denied re-certification as a result of a coding error in his medical records. Despite having over 8,000 hours of flight time, the pilot was grounded for 3 months while the mistake was sorted out. That was three months of needlessly lost income – which affects more than just the individual patient – and significant frustration.
Medical expertise and attentiveness were the only things that saved a physician from multiple unnecessary procedures as a result of an incorrect diagnostic code. Of course, ordinary people who visit the doctor don’t have that type of knowledge in reserve, and are trusting their primary care physician’s thoroughness. The frequency with which this kind of scenario unfolds is likely greater than anyone wants to imagine.
An erroneous diagnostic code was the factor that made an expectant mother’s experience anything but joyous. Her newborn’s delivery and subsequent testing were heavily influenced by this mistake, which could have been easily avoided. AmeriVeri’s mission is to prevent all of these coding errors and thus substantially enhance patient quality of care.
“Today, medical coding mistakes are among the most serious threats to patient safety,” explains AmeriVeri VP of Operations Martin Amberger. “Thousands of people every year suffer the consequences of what amount to clerical errors. Each of those cases is unique, and virtually all of them are preventable given the right tools and practices. AmeriVeri provides an innovative tool that enhances existing error-checking systems and is a final filter ensuring the highest possible level of patient safety.”
The root causes of medical coding errors are numerous, yet it’s patients and their healthcare providers that see the results. Poor communication, inadequate training, overconfidence and simple human error can all lead to mistakes in diagnosis. In addition, the vast complexity and ever-evolving nature of diagnostic coding systems is itself a challenge for providers. The newest iteration of the International Classification of Diseases (ICD) – ICD-10 – contains more than 120,000 discrete codes that healthcare providers use to capture their diagnoses.
The medical code verification system created by AmeriVeri consistently finds 3–4 errors per hundred lines of code, a number that agrees with large statistical surveys of medical billing codes. Those errors are discovered even after the data has passed through other bill review and processing systems.
AmeriVeri’s system offers effortless deployment and a zero learning curve. Rather than replacing existing systems, AmeriVeri is an enhancement and introduces an additional layer of protection that has been proven to catch coding errors both common and uncommon. Most importantly, the technology does not create any opportunity for new kinds of code errors.
Data security is tremendously important in the healthcare industry; patient records are confidential by law, and providers are obligated to safeguard patient privacy. AmeriVeri makes this easy with its encrypted FTP transfer of data. All patient data is strongly encrypted when in motion and when at rest. AmeriVeri’s process takes less than an hour, at which time clients are immediately provided a verifiable report.
AmeriVeri CR, LLC was founded in 2010, and fee options include Percentage of Net Savings, Per Line, or Per Claim. The company is privately held with offices located in Greenwood, Indiana, and Chicago, Illinois, and provides nationwide services in the Major Medical, Workers’ Comp and Medicaid arenas.
GREENWOOD, Ind., Jan. 18, 2016 /PRNewswire/ — AmeriVeri (http://www.ameriveri.com/) is on a mission to take a significant chunk out of the waste and errors that contribute to healthcare overspending. The company’s flagship software-as-a-service solution finds medical coding errors that would otherwise go undetected, providing a critical last line of defense against improper payments and inaccurate medical records. AmeriVeri’s service therefore delivers measurable and meaningful benefits to every stakeholder in the healthcare system.
According to the Centers for Medicare and Medicaid Services, healthcare spending in the U.S. topped $3 trillion in 2014; there’s no reason to think that 2015 spending did not grow by several percentage points. Healthcare spending represents about 17% of the national economy. Much of the recent growth has been thanks to insurance coverage expansions made possible by the Affordable Care Act. When dealing with such huge numbers, even small medical billing and coding errors can add up to significant waste.
The proprietary service developed by AmeriVeri detects medical coding errors routinely missed by every other adjudication process. On average, the service identifies two errors per every 100 lines of code. Using a conservative estimate of just one percent, AmeriVeri can rightly claim that its verification solution, when fully implemented, could save $6.5 billion each year for payers and employers while providing significant accuracy enhancement to providers.
“The revolution of electronic medical records has not delivered on all of its promises,” explains AmeriVeri VP of Operations Martin Amberger. “Namely, electronic records have not eliminated the problem of coding errors. Our proprietary process goes a step beyond standard adjudication processes with its Medical Necessity and Service Verification Component. The intent of the codes used is an important factor that others neglect – AmeriVeri can pick out individual lines that do not warrant payment. Payers and providers can then decide how to proceed with that feedback. ”
AmeriVeri’s service applies to $650 billion of the $3-plus trillion healthcare sector. The service offers tangible and immediate benefits in the form of increased accuracy of medical claims and histories, which contributes to a patient-centered model of care. As for capacity, AmeriVeri can process nearly one million claims in fewer than 25 minutes, and all data is encrypted and confidential, both at rest and during transfer.
The AmeriVeri SaaS solution is available to insurance and reinsurance carriers, TPAs and bill review providers. The service functions as a final accuracy check in the processing of group health, workers’ compensation and Medicaid claims. AmeriVeri integrates with any adjudication software and can be deployed at any point in the workflow.
The cost and consequences of medical coding errors go beyond a simple dollar amount. For a small practice, too much lost revenue resulting from unbilled services can lead to inefficiency and bankruptcy. Likewise, excessive errors can draw the attention of regulators or be used as evidence in malpractice cases. Physicians and hospitals thus have powerful incentives to achieve 100% accuracy, yet the rules and procedures are dynamic and complicated. AmeriVeri tackles this challenge through complete compliance with all contemporary coding standards.
From the patient’s perspective, accurate coding results in a higher quality of care. Errors in medical history can ultimately lead to improper diagnoses and treatments, which factors into the rampant overspending, not to mention leading to unsatisfactory outcomes for patients. AmeriVeri seamlessly addresses all of these dimensions.
AmeriVeri strives to make implementing its service as effortless as possible – there’s no software to install, and payment is completely transparent. Clients can choose to pay for services based on a net percentage of savings created or on a per-claim/bill basis. Either way, clients can easily see and understand how much revenue is being saved via AmeriVeri’s SaaS verification process.
GREENWOOD, Ind., Nov. 2, 2015 – AmeriVeri (http://www.ameriveri.com/) provides insurance companies, third party administrators, and bill review companies with an efficient means to save money for clients, while also staying above board with respect to utilizing the National Correct Coding Initiative (NCCI) Edits used by Centers for Medicare and Medicaid Services (CMS). The company’s proprietary SaaS solution delivers this benefit without the need to add new layers to existing processes. AmeriVeri adds tremendous – and measurable – value throughout the healthcare chain, promoting patient-centered care as well as ensuring that employers are paying only for medically appropriate and necessary claims.
“Employers and payers alike should understand the value of following NCCI guidelines,” explains Steffeny Brewer CCS, AmeriVeri Director of Code Verification. “Non-compliance opens the doorway for fraud and overpayment. For employers, a payer that avoids NCCI edits may give the appearance of cost advantages, but any savings are wiped out by excess claims and the introduction of errors into patients’ medical records. Our solution helps providers and payers utilize all available edits without adding unnecessary overhead to the already complex process of medical claims verification.”
The NCCI was developed by the Centers for Medicare and Medicaid Services to reduce wasteful overpayment and encourage a consistent and accurate coding policy for procedures and services performed by the same provider on the same date of service. The initiative consists of procedure-to-procedure edits for healthcare providers, focusing primarily on pairings of HCPCS/CPT codes. NCCI guidelines undergo continual review to ensure all procedures are in line with current coding practices and relevant national and local policies.
A key facet of the NCCI is the elimination of unbundled services, wherein a provider is overpaid because they reported separate codes for one procedure when a single code should have accounted for the entirety of the work. The NCCI does include provisions for circumstances where unbundling is appropriate. The program also incorporates Medically Unlikely Edits (MUE) to earmark claims that are logically unlikely to be correct, such as the removal of more than one gall bladder or other age, gender and time considerations.
When the NCCI identifies an edit as optional, providers can add the -59 modifier to bypass the edit. However, the inappropriate use of this modifier is rampant. Research from the Comprehensive Error Rate Testing (CERT) program indicated that the -59 modifier was responsible for $770 million in errors in 2013.
Some payers and providers prefer to limit or entirely avoid the use of NCCI edits for the sake of simplifying verification, but this practice creates a perception of sloppiness at best, or fraud at worst. Given the proliferation of electronic medical records, there’s no longer a reasonable excuse to skirt the value of represented savings and promotion of integrability of the medical claim, especially when AmeriVeri provides a seamless, effective process for utilization of the National Correct Coding Initiative.
AmeriVeri’s line-by-line verification meets all the methodological benchmarks outlined by the CMS. The process catches an average of 2 or 3 errors per 100 lines – even after those same lines have passed through the payer’s in-house error-catching mechanisms. With an unlimited verification capacity, AmeriVeri estimates the total applicable claims volume to exceed $680 billion per year.
AmeriVeri’s proprietary SaaS solution does not replace any existing system; there’s no software to install or learn. Instead, payers submit batches of medical claims via an encrypted SFTP transmission. AmeriVeri then returns a detailed report on all errors identified in one hour or less. Ultimately, the system empowers providers to focus on their patients, gives payers confidence in the integrity of medical code reporting, and saves employers money via accurate medical claims processing.
GREENWOOD, Ind., Oct. 5, 2015 /PRNewswire/ — Medical claims payers demand accuracy in coding and billing, but must balance those demands against increased complexity and added overhead. AmeriVeri (http://www.ameriveri.com/) offers a proven answer that features no charge to implement.
Most importantly, AmeriVeri’s medical code verification solution precisely identifies individual line errors at the rate of 2-3 per 100 lines that go undetected by every other process.
“AmeriVeri provides a full range of code edits, many of which are offered (to some degree) elsewhere in the marketplace,” explains VP of Operations Martin Amberger. “What sets AmeriVeri apart from other review software is our Medical Necessity and Service Verification component. This proprietary, comprehensive claims analysis tool ties together all of our edits, incorporates the intent of the codes used, and allows us to identify individual claim lines that do not warrant payment as they are listed on a medical claim.”
AmeriVeri provides its confidential SaaS to insurance and reinsurance carriers, TPAs, bill review providers, and service bundlers for group health, workers’ compensation and Medicaid claims. The service costs nothing to implement and integrates smoothly with any existing adjudication software, at any point in the workflow, and in any format currently being used.
Client end users of AmeriVeri do not have to learn or interact with any new software, widgets or apps. Instead, clients forward batches of claims through encrypted SFTP. A one-hour turnaround time is guaranteed regardless of batch size, and the company’s data security conforms to the SSAE16 Type 2 standard. The service is provided on a 100% confidential basis.
AmeriVeri’s proprietary SaaS boasts unlimited capacity, and its power has been demonstrated by processing a batch of 983,000 claims – including millions of lines – in less than 25 minutes. The service applies to annual claims that industry estimates place at $680 billion.
The immediate benefits of AmeriVeri’s solution are numerous, and include increased accuracy of medical claims and histories, as well as promotion of patient-centered care and continuity of care. Rigorous code verification protects providers from potentially expensive errors, while a new revenue source is created for payers, and measurable, significant savings are created for employers.
While the integration of AmeriVeri’s SaaS solution is fast and easy, the company provides expert consultation for clients with questions about the process. An unrelenting focus on medical coding accuracy has enabled AmeriVeri to develop a solution that is unmatched in the marketplace, and continually improving the overall service ensures that AmeriVeri will maintain its leadership position.
GREENWOOD, Ind., Aug. 17, 2015 /PRNewswire/ — Accuracy, consistency and efficiency are the value propositions of AmeriVeri (http://www.ameriveri.com/), the innovative verification solution to the ongoing challenge of eliminating medical coding and billing errors. The solution’s beauty lies in its ease of implementation and zero learning curve – AmeriVeri does not replace any existing systems or processes, but rather adds a cushion of accountability that has proven to catch even the smallest errors. As electronic medical records proliferate, so too will the need for creative strategies for combatting waste, reducing mistakes and guaranteeing patient-centered care.
“AmeriVeri enhances today’s coding and billing processes,” remarks Operations VP Martin Amberger, “and it does so without introducing new opportunities for mistakes or systems to learn. When data is submitted, our proprietary software verifies each line, and then outputs a report for the client. The system could not be simpler.”
The AmeriVeri system consistently finds coding errors missed by other safeguards and processes, and the system can be configured to meet any provider’s specialized requirements. AmeriVeri does not replace a provider’s billing system but rather adds an important new layer of accuracy assurance.
The process begins with encrypted and secure FTP transmittal of provider data. In less than an hour, AmeriVeri returns a full report of the data in any format requested by the client. The report earmarks problematic lines, providing a reason code and description in each case to support the system’s recommendation of nonpayment. Providers can choose whether to correct any line errors and resubmit for payment, as the circumstances warrant.
Every provider takes its own approach to resubmittal. A high rate of resubmissions, for instance, indicates that AmeriVeri is identifying bona fide errors that could affect the continuity of patient care, and the provider is being faithful and proactive in terms of accuracy. Alternatively, employers and payers can realize substantial, measurable savings when providers resubmit billing codes less frequently. The beauty of AmeriVeri is its seamless adaptability to a variety of usage scenarios.
Reporting on the American Medical Association’s 2013 National Health Insurer Report Card, Healthcare Payer News examines how the “cost of getting paid” absorbs too much revenue from the typical medical practice. In the meantime, private insurers waste up to $12 billion annually by not incorporating innovative automation to claims processing and payment. AmeriVeri offers a proactive solution for providers that want to optimize their revenue stream and trim the costs associated with systemic errors.
Those mistakes, of course, often result in more than a simple clerical error. Inaccurate patient histories and misdiagnoses can have far-reaching impacts. Similarly, ongoing healthcare reform and the subsequent growth of the insured population have put new pressures on insurance companies to maintain their profit margins. AmeriVeri protects all parties in the healthcare transaction through its verification of medical coding and billing.
Concluded Amberger: “The combination of healthcare reform and electronic medical record keeping have pushed many healthcare providers to their administrative and technical limits. AmeriVeri provides needed verification and accuracy.”
AmeriVeri CR, LLC was founded in 2010. The company is privately held, and is located in Greenwood, Indiana. Our nationwide team provides services in the major medical, workers’ comp and Medicaid arenas.
Founded in 2010, AmeriVeri’s software-as-a-service solution represents the input of 42 healthcare technology experts. “Existing software generally only checks code validity, so other types of errors can still enter the system. We go well beyond checking that a particular code is valid,” explained Claims Management Team Leader Steffeny Brewer. “Our solution determines whether the specifications for a particular code actually exist and that diagnoses and procedures are appropriately matched.”
AmeriVeri boasts the computing resources to process every major medical, group health, workers’ compensation and Medicaid claim made in the US on any given day, verifying code accuracy at the rate of one million claims every 25 minutes. Should a line be rejected, the system provides specific reasoning, streamlining any manual editing work. Turnaround time for a typical batch of claims is one hour from submission to return. Implementing AmeriVeri’s solution is simple, and data is encrypted during transmission as well as when static.
In an investigation into the architecture of healthcare billing, the Cleveland Plain Dealerreported that roughly 250 people have a hand in creating a single hospital bill. That’s 250 opportunities for errors to be introduced, and these errors not only cost time and money but also negatively impact quality of care.
Government payers are just as vulnerable to coding and billing errors. According to Medical Economics magazine, Medicare claims for evaluation and management in 2010 had an error rate of 42%. As a result, the federal government paid out $6.7 billion for incorrect codes. The Medicaid error rate may be even higher; therefore any improvements to the verification process should result in substantial savings.
AmeriVeri is available as an added service to Payers including both TPAs and Insurance Companies, and Employers benefit by helping to assure Continuity of Care and by not paying for improperly coded services. Because healthcare costs as a portion of labor costs have been on a steady climb, any opportunity to increase efficiency is certainly attractive. Payers, meanwhile, benefit from protecting their provider network, and by generating an additional revenue stream.
AmeriVeri’s software-as-a-service solution is flexible and adaptable to the needs of end users. The software can be inserted at any point in the claims processing workflow. Rather than replacing an existing step, AmeriVeri provides a seamless extra layer of certainty and security – a valuable asset in the event of an audit. The software can likewise scale rapidly to handle volume increases. Medical office staff, meanwhile, can spend less time editing documentation and more time delivering patient care.
Added Brewer: “The ready availability of medical records has meant that patients are more involved with their care than ever, and that trend is only going to continue. AmeriVeri offers patients a new level of assurance that their records are true representations of care provided.”
AmeriVeri CR, LLC was founded in 2010, and fee options include Percentage of Savings and Flat Rate. The company is privately held with offices located in Greenwood, Indiana, and Chicago, Illinois, and provides nationwide services in the Major Medical, Workers’ Comp and Medicaid arenas.