Wolves at the Door: E/M Coding Now

Advance News Magazine published an article titled: "Wolves at the Door: E/M Coding Now: Documentation is More Important Than Ever".   In this article, they discussed the following:

• OIG Uses Data Analytics
• Coding Trends of Medicare Evaluation and Management Services - 2001-2010 Part B goods and services.
• The OIG stated that E/M coding "has been vulnerable to fraud and abuse".
• Data analysis identify types of E/M services with improper payments for Part B services.
• The OIG identifies specific physicians who bill higher-level E/M codes
• If you're already a target, you should address the following:
• Look at your practice policy and procedures (P & P) manual
• If your coding is outsourced, work with vendors
• You should also perform internal documentation and coding audits
• If you have more than one coder have them do a quality assurance (QA) review of another coder's work.
• Provide the same case to all your coder's and see what the outcomes are and if there are any differences.
• Have an outside consultant perform documentation and coding audits.

To view the full article, please click the following link: Wolves at the Door: E/M Coding Now

For additional billing, coding and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources

Hospitals Crack Down on ED Repeat Users

Health Leaders Media published an article titled: "Hospitals Crack Down on ED Repeat Users". Key points from the article were as follows:

• Case Manager Plan
• St. Luke's Hospital implemented a plan to identify those who were "frequent fliers" patients who visited the ER 12 times in 12 months.
• Many of these patients go to the ER for various reasons such as: they don't have a family doctor, they lack finances or they may be unable to make their doctor's hours.
• This hospital has estimated that they have saved about a half million dollars by not having to provide additional care and testing for these so-called "frequent fliers"
• Creating a Direct Relationship
• In Massachusetts, many of their "frequent fliers" or as they called them "MVPs" did have primary care physicians.
• The issues that these patients dealt with were more psychological, social and economic issues.
• Following the Care Plan
• Patients receive a letter if they have gone to the ER for more than 12 times.
• They make sure the patient understands the treatment program from their last Emergency Department discharge.
• Technology and Diabetes
• The article stated that in one study 11% of ED visits at two particular hospitals was for diabetic visits.
• They came to the conclusion that patients were not getting the care they needed.
• Behavioral Care and Insurers
• Lack coordination which results in a negative impact on individuals
• Changing Behavior
• The change for these Emergency Departments has shown good results
• No Cure Yet
• Although, improvements have helped at many hospitals, the problems with frequent fliers in the Emergency Department still has a long ways to go.

To download the full article, please click the following link: Hospitals Crack Down on ED Repeat Users

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page

Reducing Emergency Department Overuse

Overuse of the Emergency Department for non-urgent or avoidable visits costs the U.S health care system an estimated $38 billion/ year. A Research Brief was published by New England Healthcare Institute Reducing Emergency Department Overuse. The brief covered the following topics:

• Who overuses the ED?
• What are the root causes of the problem?
• What are the consequences of ED Overuse?
• Solutions
• Redesign primary care services
• Telephone Access to After-Hours Consultation
• Extended Practice Hours
• Open Access Scheduling
• Group Visits or Shared Medical Appointments
• Access to Appropriate Services
• Outreach to Primary Care Providers
• Connecting Vulnerable Patients to Appropriate Services
• Provide Alternative Sites of Primary Care for Non-Urgent Conditions
• Urgent Care Services
• Worksite Clinics
• Telemedicine
• Improve Disease Care and Management
• Provide Patient Education
• Offer Patients Financial Incentives
• Increased Co-payments for Non-Urgent Use
• Healthy Rewards Accounts
• Collect Improved Data on ED Use
• ED Census Reports
• Predictive Modeling
• NEHI Recommends the following: 
• Establish collaborative relationships among EDs, primary care providers and community services
• Understand the Patient Population
• Reform payment for primary care services
• Invest in health information technology
• Increase the primary care workforce
• Redesigning primary care services

To view the full study, please click the following link: "Reducing Emergency Department Overuse"

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

Patient Charges for Top Ten Diagnoses in the Emergency Department

PLOS One published an study titled: "Patient Charges for Top Ten Diagnoses in the Emergency Department".

• The study was conducted to examine charges, variability, payer group for diagnosis & treatment for the 10 most common outpatient conditions in the Emergency Department.
• The study was conducted from a 2006-2008 Medical Expenditure Panel Survey, patients aged 18-64 years of age who had a single discharge diagnosis.
• The study covered 8,303 encounters which represented 76.6 million visits.
• The study concluded that ED charges for common conditions are expensive with high charge variability.
• A few of the top ten diagnoses were the following: Headaches, Sprains and Strains, Upper Respiratory Infection & Back Problems
• The purpose of the study was to allow patients and providers become aware of ED charges that patients may face in the current health care system.

To view the full article with all top ten diagnoses, please click the following link: Patient Charges for Top Ten Diagnoses in the Emergency Department

For addition billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources Page.