Increased exposure to financial risk and penalties
As the federal government continues to pursue healthcare organizations to ferret out fraud and abuse, healthcare organizations must not only be vigilant in implementing, maintaining, and updating their organization’s compliance programs, they must also ensure accurate and complete coding.
The current climate of government scrutiny in healthcare dictates the need for adherence to accurate coding and billing processes including relevant documentation of medical billing codes, and proper charging of insurers for medical services rendered. Patient care, data integrity, compliance, and reimbursement are at risk when the severity of the illness, treatment provided, and mortality rates aren’t documented and coded accurately.
Since the conversion to ICD-10, healthcare organizations are increasingly challenged with coding and DRG accuracy rates far below industry standards. In fact, in a recent study by Becker’s Hospital Review:
Average outpatient coder accuracy was found to be 41 percent.
Average coding accuracy for DRG codes was found to be 72 percent.
Representing a net financial decrease of $754 per case.
Identifying incorrect coding is the key to driving compliance and decreasing fraud and abuse penalties
With the grace period now over and 6,000 new codes released, clearly continuous assessment of coder knowledge in ICD-10 and CPT coding, and education and training to address knowledge gaps is a need. Harmony Healthcare offers an undeniable value-proposition to healthcare organizations hoping to reduce risk. Investing in staffing and consulting solutions is a strategic way to maintain compliance. With the right partner, healthcare organizations are free to focus their time and money on what counts—the patient.
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How we drive compliance and decrease fraud and abuse penalties
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