2013 has been quite a year for the whole allied healthcare industry. A number of high-profile cases concerning coding and billing fraud made headlines last year, and so did the hullabaloo surrounding the impending ICD-10 update. Found below are the top two headlines that caught our attention relating to CBCS certification and billing and coding specialist certification, and the coding and billing sector in general, last year.
“One Code Fits All” Adoption
The Center for Medicare and Medicaid Services (CMS) has proposed last July that it will be replacing its current levels of service for emergency department (ED) and hospital clinic evaluation (E/M) coding, according to a news report on the AAPC website. According to the report, the proposal aims to replace the levels of practice with a uniform Healthcare Common Procedure Coding System (HCPCS) for each type of outpatient hospital visit. What does this mean? This means that for reimbursements for ED HCPCS code, it would now depend on an average of five ambulatory payment classifications (APCs). Sounds a little tricky, we know, but according to the CMS, the proposed rulemaking aims to reduce upcoding incidences and remove hospital incentives that translate to the provision of unnecessary health care services and more of course, more work for the admin.
A number of organizations like the American Hospital Association and the American College of Emergency Physician were not in favor of the implementation of the code, because according to them, the said code doesn’t necessarily apply to the emergency department and ambulatory medicine. The adoption of one code for all levels would also be unfair to EDs located within the city which treat high acuity cases. Another negative impact of the single coding scheme is more bundling of services and reduced payments, which could result to lower quality of patient care delivery.
What’s the final verdict? According to the CMS 2014 OPPS and ASC final ruling, which was released on November 27, the one-level coding for ED will not be implemented as the CMS would like to study which payment system is right for ED visits. However, a new single coding level (HCPCS G0463) will be implemented for Medicare payments in 2014 for E/M services. CMS believes that this decision will streamline the payment system for ambulatory clinics.
ICD-10 Updates: Emphasis on Dual Coding
We have published a series of blog posts on ICD-10 throughout the year and as we near the end of our journey to the ICD-10 implementation within a few months, we thought of reviewing some of the best practices that we must consider right now. And one of which concerns dual coding.
Dual coding, or double coding, whichever term you call it, has been met with a hot-cold response since it has been suggested by allied healthcare experts and healthcare regulatory bodies. According to Deloitte Consulting leader Chris Armstrong, applying dual coding early on can help institutions adjust in terms of costs and productivity. “Doing it earlier in the process means incurring those costs earlier,” he told Bonnie Cassidy, an Advance Web columnist, in an interview.
What’s the best way to apply dual-coding? How can institutions make most of it? Cassidy recommends the following elements, based on Wolters Kluwer business development manager Maria Bounos’s recommendations:
A stronger teaching method. Nothing can beat detailed training and a trial run to save up on overall training expenditures. Accredited medical billing coding schools
Building confidence. Coders gain confidence as they master the new coding system in a controlled environment, and as they accomplish more coding assignments.
Documentation assessment. Dual coding saves institutions time and money for catching errors and missing documentation, and improving overall clinical documentation. Dual coding also eliminates the need for the services of a third-party provider documentation assessment.
Database evaluation. Dual coding provides a collaborative testing environment for both payers and coders.
Financial analysis. According to Buonos, dual coding offers financial analysts foresight when it comes to financial planning, especially for the next ICD update (ICD-10.2).