Physician Practices Examine Risk Adjustment Coding in Wake of Federal Lawsuits

Published: Wed, 09/27/17

A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't involve physician practices, many practices are now paying more attention to risk adjustment coding than ever.

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Looking at new ICD-10-CM Codes for Blindness

ICD-10 codes for blindness and low vision are effective Oct. 1, 2017 and reflect parameters from the World Health Organization (WHO). A new set of codes was released for use beginning on Oct. 1, 2017. The category, H54, includes codes for blindness and low vision and with that brings many changes for documentation and coding.

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OIG: Acute Care Hospitals Owe Medicare $51.6M, CMS Agrees to Provider Clawbacks

A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the money back.CMS has agreed to claw back the $51.6 million and require hospitals to refund patient copays and deductibles.

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What Was Missing at the ICD-10 C&M Meeting?

Much was covered during the ICD-10 Coordination and Maintenance Committee (C&M) meeting last week at the Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore. The first striking item was that there were no...

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Turning Around a Troubled Revenue Cycle

Accurate, efficient revenue cycle management is essential to maintaining positive cash flow in a healthcare facility. Maintaining positive health care finances requires that claims processing and payments are effectively managed and that claims are "trackable at all points so issues can be addressed in a timely manner...

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