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Avoid Fraud and Overpayment: AmeriVeri Emphasizes Importance of Using National Correct Coding Initiative to Reach 100% Clean Medical Claims

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.

AmeriVeri Finds Medical Coding Errors Missed by Every Other Process, in 1 Hour

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.

Proprietary Solution From AmeriVeri Identifies Medical Coding Errors Before Payment

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.”

About AmeriVeri

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.

AmeriVeri Helps Assure Accurate Medical History and Claims, Protect Provider Networks, and Save Money

 GREENWOOD, Ind.June 2, 2015 /PRNewswire/ — Medical coding errors are costly for everyone involved, yet they remain disturbingly common even in this age of electronic medical records. Reducing those costs and assuring the accuracy of patient records is the mission of AmeriVeri (http://www.ameriveri.com/), a healthcare technology firm with an innovative, proprietary solution to the ongoing challenges of medical coding and billing.

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.”

About AmeriVeri

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.

http://www.reuters.com/article/2015/06/02/ameriveri-med-claims-idUSnPn1WTLXd+9e+PRN20150602

 

More Health-Care Insurers Seek Big Premium Increases

From the Wall Street Journal:

The Obama administration published more information about hefty 2016 proposals

By LOUISE RADNOFSKY and STEPHANIE ARMOUR

June 1, 2015 8:47 p.m. ET

WASHINGTON—The Obama administration published more information Monday about hefty premium increases for 2016 sought by large insurers selling plans under the health law.

Major carriers from around the country are proposing big increases in the premium rates paid by consumers who buy insurance policies on their own.

Blue Cross and Blue Shield of Illinois is looking to raise rates by averages of 29% or more. In Pennsylvania, Highmark Health Insurance Co. is asking for 30%, according to proposals submitted by insurers for the year ahead. Around the country, some of the main market leaders are looking for double digit increases.

The new requests for premiums come at a time when the political and legal future of the law hangs in the balance. The Supreme Court is set to issue a decision later this month on the validity of the law’s tax credits to offset the cost of premiums for lower-income consumers in most states in the country.

Republicans opposed to the health law still plan to make it part of their 2016 election campaign, and for the law’s Democratic supporters, the proposed rate increases mean a tough conversation about how the law is working.

Some of the significant increases being sought were first reported in The Wall Street Journal.

As part of the 2010 Affordable Care Act, insurers must justify increases of 10% or more to the Obama administration, which published those explanations online Monday. The administration cannot force insurers to reduce rates, but many state regulators can negotiate with health plans, and the rates could come down.

The Obama administration sought to emphasize that point on Monday.

“The rate review process kicks off an important set of steps designed to provide consumers and others the opportunity to weigh in on proposed rate increases of 10% or more,” said Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, which oversees the health law’s implementation. “These specific rates will be subject to vigorous rate review and revision.”

Some of the insurers couldn’t immediately be reached for comment following the Department of Health and Human Services’ publication of the data Monday.

But Greg Thompson, a spokesman for the Illinois insurer, said rate proposals reflected the health plan’s medical claims, and noted provisions in the health law that require insurers to spend the vast majority of premium income on claims or refund the difference to consumers.

Other insurers also have said their rates for the year ahead reflect the impact of the law’s sweeping changes to the way health insurance is sold and priced.

Under the health law, plans have to sell coverage to everyone, regardless of their medical history, and can’t charge people who are more seriously ill higher rates. Health-plan officials say that means they are bearing bigger medical claims than they had expected.

Moreover, insurers have said they face substantial pent-up demand for health-care services from the newly enrolled, including for expensive drugs.

Consumer groups contend they want state and federal regulators to be as tough as they can on insurers’ requests to raise rates.

Dena Mendelsohn, a health policy analyst at Consumers Union, said that Monday’s information didn’t present a full picture of insurers’ requests for the year ahead because HHS only publishes the proposals for insurers seeking rate boosts of 10% or more. But she said she was aware that large insurers were among those asking for significant boosts.

“I do see a lot of [percentage] increases in the mid-teens to 20s, which is troubling, but it’s a limited picture,” Ms. Mendelsohn said. “We want to make sure the underlying factors are there to support it, like increasing cost of pharmaceutical drugs.”

Some observers said the requests reflected other ominous signs.

The companies with the biggest market shares are raising rates, signaling they don’t care if that causes them to lose enrollment, said Bob Laszewski, at Health Policy and Strategy Associates LLC in Alexandria, Va.

“This is not a good sign,” he said. “These people are saying they don’t care if they keep the business. They don’t want it if it’s not profitable.”

Those with lower increases still above 10% also include smaller carriers, but the larger operators have more data, he said. “We have a trend of the big market share companies asking for 15% to 35%,” Mr. Laszewski said.

PHI Disclosure Management Strategy

With the overwhelming amount of breaches of personal health information, PHI disclosure management  has become a top priority. With the approaching audits from the US Department of Health and Human Services Office for Civil Rights a PHI disclosure management strategy can provide a more compliant environment. The article below addresses the workflow challenges and standardizing process, and how to create consistency and reduction of the workload.

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050882.hcsp?dDocName=bok1_050882

Consumerism in Healthcare

Consumerism affects every aspect of healthcare from the clinical setting to the health information management department… Or at least this is the way it should probably relay through the healthcare system.

Unfortunately, very few have integrated consumerism into their healthcare system nor made consumerism the focal point.  The advent of mobile health (mHealth) coupled with the patient engagement movement will increasingly accelerate the changes already underway in healthcare. HIT professionals will need to jump on board now or be chasing the caboose later. This a very informative article giving key points on such areas as transparency with patients’ healthcare records, doctors notes, and the cost of healthcare based on health contracts.

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050820.hcsp?dDocName=bok1_050820