“Failing to thoroughly document signs and symptoms, assessments, and treatments of chronic diseases creates a ripple effect of misfortune. First, all relevant codes are not captured; this leads to improper payment (not to mention, an injustice to the patient). The next thing you know, the claim fails a Risk Adjustment Data Validation (RADV) or Office of Inspector General (OIG) audit based on insufficient documentation. The final blow is a funding take-back. Physicians know this, but many of them do not know how to document sufficiently to support the eight to 10 (or more) diagnoses they might list in the assessment. This is where the healthcare business professional’s expertise comes into play.”
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“Medical coding is a major factor in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment.”………. Click the link to continue reading this article https://www.verywell.com/basic-rules-for-medical-coding-2317087
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.
“While accuracy has always been essential, its importance is unparalleled now due to two dynamics: the increased specificity of ICD-10, and the quality improvement requirements of value-based care models. Both of these things are compelling providers to document more detailed information, which certainly adds to already significant workloads and that have been estimated to add 1 to 2 hours per work day”…………To continue reading this article please click on the following link.
While it is understood that coding and the accuracy of coding does have a financial impact in all organizations, the primary purpose of coding accurately and completely should not be done for dollars. Coding is the language that translates the severity and acuity of the patient and all conditions of the patient and links them to the services being rendered for each unique patient. Coding not only paints the picture of the complexity of the patient, but supports the quality medical care and services provided……
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“You know there are times when you need to make something fit but it just won’t. Like a time when all of your information
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.