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CDI and Quality Initiatives

“Documentation that does not support the diagnosis and procedure codes submitted can lead to a reduction, denial, or take back of payments as well as inaccurate quality scores. No matter what the setting is, the goal of clinical documentation improvement (CDI) is to assist in ensuring quality documentation. The documentation must be reliable, precise, complete, consistent, clear, legible, and timely.”

“Can CDI have an impact on quality initiatives? Certainly! The core of many quality initiatives is the health record and the documentation contained within. This article will present a high-level view of some of those quality initiatives and how CDI can help with the attainment of accurate, quality documentation to support the quality initiatives.”

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MDM: The Driving Force in E/M Assignments

“The medical decision-making (MDM) component of evaluation and management (E/M) services is perhaps the most crucial element in determining the correct level of service assignment for patient encounters. The majority of individuals involved in the E/M coding process may not agree on the interpretation of the components, but would agree that the clinical thought process expressed in the MDM components best describes the level of medical necessity, as well as the level of service necessary for that specific problem.” please click the following link to continue reading the article:




Despite federal delays, bundled payments will be entrenched in US healthcare

“Amid yet another delay in CMS-led bundled payment programs, the popular value-based reimbursement model seems poised to continue as a favorite for providers. Bundled payments serve as an entry to value-based care because of the relatively low risk providers take on. And while these programs aren’t yet proven to be successful, there is enough positive data to excite those who champion paying for healthcare based on value.”  Please click the following link to continue reading

Engaging Providers Key to Value-Based Reimbursement Adoption

“Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent Bain & Company survey showed.”  please click on the following link to continue reading the article


AmeriVeri Provides Solution to End of “Unspecified Code” Era AmeriVeri provides ICD-10 code specificity solution to improve health outcomes and rein in costs.

GREENWOOD, Ind., Oct. 10, 2016 – On October 1, 2016 CMS ended the one year ICD-10 flexibility period. If providers now submit claims with unspecified codes when other, more specific, codes are available, CMS review contractors can deny their claims. If providers continually submit inaccurate codes, it can be a red flag which in turn can lead to an audit. To avoid being audited, CMS recommends that providers “code claims to the degree of specificity supported by the encounter and the medical documentation.” AmeriVeri (, a provider of enhanced medical code verification services, helps affected parties meet these requirements, assuring the highest level of medical code specificity, and leading to more accurate patient histories.
This enhanced level of code specificity affects the collection of accurate and complete coded data, and is critical to such areas as healthcare delivery, public reporting, research, reimbursement, and policy making. Ensuring the integrity of coded data and the ability to convert the raw data into functional information requires that all official coding rules, conventions, guidelines, and definitions are consistently applied and updated. The use of uniform coding standards reduces costs, enhances data quality and integrity, and improves decision making, which leads to higher quality healthcare delivery and information.
AmeriVeri’s experience and research indicates the rate of unspecified code use today is at 31.5%. The goals of increasing code specificity are to improve health outcomes and to rein in the cost of healthcare in America. While the migration to ICD-10 and the demand for increased granularity has required a significant upfront investment, the payoff is expected to be substantial.
“A recent report provided to a workers’ compensation insurance client demonstrates the tremendous value of our process,” says AmeriVeri VP of Operations Martin Amberger. The report verified that nearly 800,000 claim lines were processed representing a total of $154 million. Errors were identified in 69,685 claim lines – a rate of about 11%. AmeriVeri has potentially saved this client more than $13 million.”
“Moreover, ICD-10 code specificity is just one aspect of the AmeriVeri verification service. We also provide a host of edits that collectively guarantee a high level of code accuracy.”
In the column of descriptions of why lines are marked as errors, a few items stand out. For instance, “Invalid DX Code” accounted for a big percentage of all errors and occurred at a relatively high rate. Similarly, the “Medical Necessity” edit – a proprietary component of AmeriVeri’s review system – contributed to $2.7 million of the $13 million in total savings. Both of these descriptors correlate to unspecified or insufficient ICD-10 codes.
AmeriVeri’s value proposition is that its code verification system averages finding 3 errors per hundred lines of code – even after claims have passed through adjudication software processes.
 The end of the ICD-10 unspecified codes grace period is not the only change that providers and payers are seeing this year. Nearly 2,000 new diagnostic codes will be added to the manual. Additions and revisions happen every year, but this year’s conjunction with the end of the grace period creates a double challenge.
Providers who are slow to adopt the new ICD-10 standards are likely to see their revenue trend downward. Alternate payment models based on patient outcomes will demand more specific codes. Therefore, the time to understand and implement these specificity rules is now. AmeriVeri enables a virtually seamless transition for both providers and payers.
“Looking ahead, accurate and precise medical coding will continue to be a vital part of guaranteeing quality of care for patients, and cost savings for payers,” concludes Amberger. “From a broader perspective, consistent coding practices are essential for planners and researchers looking to improve access to healthcare and identify areas where
more investment may be needed. AmeriVeri helps make all of this possible, without adding complexity.”
About AmeriVeri CR, LLC
AmeriVeri was founded in 2010. The company is privately held with offices located in Greenwood, IN, and Denver, CO, and 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.
Jim Baughman
888 354 8776 ext. 701

AmeriVeri Announces Unique Implementation of NCCI Code Edits as Part of Proprietary Medical Code Verification Technology

GREENWOOD, Ind., August 1, 2016 –
AmeriVeri (, the medical codeverification software-as-a-service, has recently enhanced its implementation of NCCI (National Correct Coding Initiative) code edits, and clients have taken note of the benefits. These include,above all, a higher-than-ever level of assurance that medical records are accurate prior to payment and archiving.
The Center for Medicare & Medicaid Services, developer of the NCCI, has recommended that all healthcare providers and payers apply these edits to their code verification process. These edits include code pairs that realistically should not be submitted together, including those that are mutually exclusive. The motivation behind the NCCI, which was first deployed in 1996, is to trim the waste that historically has plagued government healthcare systems. The initiative’s methodologies, however, are fully applicable to private systems as well. In parallel with other verification tools, NCCI edits are an important piece of the data integrity puzzle. AmeriVeri makes it easier for all financial stakeholders in the healthcare industry to assemble that puzzle.
“Data integrity is quickly becoming the most important area of processing and archiving medical
claims,” explains Steffeny Brewer, AmeriVeri Director of Claims Management. “Coding errors that go undetected are prohibitively time consuming and expensive to fix. Moreover, errors undermine the accuracy of patient histories and can drag down overall quality of care. At AmeriVeri, we’ve designed a system for reporting NCCI edits that empowers providers to apply the appropriate modifications – ensuring both data integrity and a leaner, more efficient healthcare system.”
Every stakeholder in the healthcare industry is attuned to solutions that address the challenge of producing and maintaining accurate medical records. Unfortunately, the complexity of today’s healthcare infrastructure, which includes mandatory adoption of electronic health records, provides countless opportunities for the introduction of errors. Once a payment has been made in error or a record archived, it’s nearly impossible to backtrack. Between private insurers and Medicaid, the cost of medical billing errors totals several billion dollars annually.
AmeriVeri routinely identifies 2 to 3 errors per 100 lines of code, even after that code has been inspected by other software tools. Of course, the AmeriVeri solution was engineered with more than simple cost savings in mind. The accuracy of patient medical records has lasting consequences for the continuity and quality of patient care. A significant portion of medical errors are the result of coding mistakes that were never caught. Even ignoring the health and wellness aspect, billing errors can lead to overbilling – and the current system is too complex for average patients to know a mistake when they see it.
Clients of AmeriVeri include insurance and reinsurance carriers, third party administrators, bill review providers, fraud and abuse specialists, and cost containment experts, among others. The company continues to deliver value and innovation within the healthcare billing and medical records accuracy space, and add to its bevy of proven competitive advantages.
AmeriVeri’s software-as-a-service deploys in about an hour, and provides a line-level verification of medical codes. One million claims can be processed in an hour or less producing reports listing problematic codes and the rationale for their tagging in whichever format the client requires.
About AmeriVeri CR, LLC
AmeriVeri was founded in 2010. The company is privately held with offices located in Greenwood, IN, and Denver, CO, and 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.
Jim Baughman
888 354 8776 ext 701

Incorrect Medical Coding Corrupts the Core Data Used by Health Care Facilities, Has Negative Consequences Throughout Health Care Industry

AmeriVeri provides seamless, pre-payment code verification to address this challenge
May 31, 2016, 08:30 ET
May 31, 2016
/PRNewswire/ —
Guaranteeing accurate, consistent medical codes and patient histories is one of the major challenges for providers and payers today. Medical codes are the starting point for understanding quality of care and making needful improvements. AmeriVeri ( provides a code verification process to ensure accuracy and consistency, making benchmarking and improvements possible.
“Medical codes are the core data used in every aspect of modern health care – every provider, payer and facility relies on them,” explains AmeriVeri VP of Operations Martin Amberger. “The accuracy of codes
therefore has a direct relationship with overall quality of care and the effectiveness of the system as a whole.”
Medical coding quality has an impact on multiple aspects of the health care industry. Reimbursement,
benchmarking, clinical and financial decision making, policy adoption, and research, among other domains, are
all dependent upon accurate medical codes. Moving forward, the system faces significant challenges related to
consistency in benchmarking coding quality; identification of the sources of coding errors; assessment of
strengths and weaknesses of individual coders to develop educational best practices; and assurance that all
codes represent quality data.
Injury and death are only the most serious consequences of medical coding mistakes. Overbilling customers is another possible outcome. Health finance professor Dr.Stephen Parente estimates that 30 to 40% of medical bills contain errors; the Access Project puts that figure closer to 80%. Meanwhile, Kaiser Health News concludes that $68 billion in lost health care spending can be attributed to medical billing mistakes.
The most recent iterations of coding guidelines have begun emphasizing quality of care and patient safety via
more specific codes. However, the success of that strategy still depends entirely on accurate reporting by
providers and others who handle medical codes. At the same time, several national initiatives on medical
coding have been deployed that further emphasize accuracy.
The Center for Medicare and Medicaid Services (CMS) has made Pay-for-Performance programs a priority, and
they’re rapidly expanding nationwide within both CMS and other providers. With Pay-for-Performance, providers
receive differential payments based on specific measures like patient satisfaction, clinical outcomes, structural
reforms (e.g., new IT systems) and quality of patient care. Aligning financial incentives to the delivery of optimal
care has the potential to measurably improve the efficiency of health care. Because Pay-for-Performance looks
at measures that are typically assigned a medical code, the importance of accuracy in those codes is amplified.
AmeriVeri’s answer to this challenge is a pre-payment solution that improves patients’ care and ensures
accurate medical histories. This added layer of protection offers tangible benefits to both payers and employers.
Payers enjoy peace of mind knowing their network has another layer of protection, while also receiving an
additional revenue stream. Employers can realize sizable savings for their organization and provide their
employees with continuity of care.
Standard, in-house claims management software has its shortcomings, as numerous studies have
demonstrated over the years. Errors not captured prior to payment are difficult to correct and can have lasting
effects, including both overpayment and inaccurate patient records, or worse – patient injury or death.
AmeriVeri consistently captures 3 to 4 coding errors per 100 lines of code, can verify the code accuracy of 1
million claims in 25 minutes and does so without adding new systems or tools to learn.
About AmeriVeri
AmeriVeri CR, LLC was founded in 2010. The company is privately held with offices located in
Greenwood, Indiana and Chicago, Illinois, and code accuracy is verified nationwide in the Major Medical, Workers’ Comp
and Medicaid arenas with a 1 hour turnaround.
Additional information:
Contact: Jim Baughman, 888.354.8776 Ext 701, or

The How to of Improving Medical Documentation and Coding Practices

“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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Query Physicians to Improve Documentation and Dx Coding


AmeriVeri Supports Transition to Value-Based Payment Programs –and Enhances Their Effectiveness

GREENWOOD, Ind., Jan. 10, 2017 /PRNewswire/ — Medical code verification services provider AmeriVeri ( 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.


Jim Baughman
888 354 8776 ext. 701