Why Your EHR System Might Get You Audited: ICD-10 Dropdown Menu Fails

  • Margaret Klasa DC, APN BC
  • Mar 15, 2017
  • Comments
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Most EHR systems have drop-down menus in which ICD-10 code choices or search returns are in numerical order where say the fifth digit of 0 – indicating unspecified – is the first return or choice, while the more specific choices are farther down the list. Physicians are often picking the first code that appears in the drop-down menu therefore claims may be at risk due to continuous submission of unspecified diagnoses.

EHR Coding, Medical Coding, ICD-10,

RAC Ramp Up for 2017

  • Margaret Klasa DC, APN BC
  • Feb 27, 2017
  • Comments

The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month. The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 ....

Medicare Pricing, Program Integrity, CMS audit, Medicaid, FFS Audit, Compliance,

OIG Work Plan FY-2017 - Monitoring Claims for Potential Fraud

  • Cindy Gallee, JD, RHIA, CHC
  • Jan 25, 2017
  • Comments
Monitoring Claims for Fraud-canstockphoto25652629

The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful guidance for healthcare providers and payers to monitor their claims for potential fraud and quality of care concerns. The Work Plan (at https://oig.hhs.gov/reports-and-publications/workplan/) details areas where OIG will focus their review efforts by type of provider.

Fraud, Waste and Abuse, OIG,

Context 4 Healthcare, Inc. announces the latest addition to the Medicare pricing capability of the DecisionPoint Pricing System – Skilled Nursing Facility

  • John Danza
  • Dec 05, 2016
  • Comments
DecisionPoint Pricing System

Context 4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the Skilled Nursing Facility Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. This latest addition further expands the DecisionPoint Pricing System, the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims duri ...

Pricing, Reference Based Pricing, Medicare Pricing,

New HCPCS Modifiers for 2017 Impact Reimbursement Rates

  • Margaret Klasa DC, APN BC
  • Dec 05, 2016
  • Comments
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The Centers for Medicare & Medicaid Services (CMS) has established 2 new HCPCS modifiers that will affect reimbursement rates for the year 2017. The first new HCPCS modifier is FX, which is X-ray taken using film. The Consolidated Appropriations Act of 2016 (Section 502(a)(1)) Medicare Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Medicare Imaging Payment Provision amends the Social Security Act by reducing the payment amounts under th ...

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