Category Archives: Medical Coding Services

Medical Coding Services provider, Nearterm, offers news  and commentary on key medical coding issues.

Medical Coding Managed Services

Medical Coding Services

Do you have a medical coding backlog?

Are you behind on your coding audits?

Need a Coding Audit Program?

Never fear, Nearterm is here!

We help healthcare organizations meet their coding and coding audit needs as part of our overall 360 RCM Managed Services.  Our national client base includes hospitals, clinics and other provider types. All of our medical coders and auditors are credentialed, certified, vetted, professionally managed, and located in the United States. Nearterm coders are held to productivity and accuracy metrics that exceed industry standards.

In addition to the medical coding and audit services described above, Nearterm also provides leadership, implementation support and project management services for all RCM activities and projects. We offer a comprehensive 360 solution from patient access to accounts receivable resolution. Nearterm resources can work from remote locations and/or onsite, whatever your organization requires of them. Nearterm can deliver top notch talent for:

  • Interim Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support)
  • Technicians (Billers, Collectors, AR Specialists, Coders)

If you need help, Nearterm is ready to deliver! Ask A Nearterm Expert.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

 

Posted By: nearterm-admin

A Deluge of ICD-10 CM/PCS Codes is Coming to All Healthcare Facilities: What to Do?

Jim Matthews  ICD-10 CM/PCS
Jim Matthews, Principal, Nearterm Corporation

On October 1st of this year, a deluge of over 5,000 new ICD-10 CM/PCS medical codes and other changes are coming to hospitals and clinics nationwide. The stakes are high so it is important to get it right the first time. Errors may lead to delayed or denied claims, negatively impacting the revenue cycle management process and, therefore, cash flow.

On top of that, complying with ICD-10 CM/PCS requires a substantial investment in education and technology, pushing the stakes even higher.

Below, Nearterm offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS. The big one is to create a Plan of Action (POA) to uncover and address shortfalls and unpreparedness in all RCM functional areas.

HIM Management

  • Develop a POA. Determine the level of quality and sufficiency in current coding and documentation processes by doing a formal discovery and assessment. Research might reveal that a Clinical Documentation Improvement (CDI) program is needed or should be All relevant Changes to PracticeWork Flow and Business Processes should be covered in the POA.

Medical Coding & CDI

  • Ensure all Medical Coders and CDI specialists are trained on the new/revised codes and how they may impact current business
  • Update CDI and Medical Coding policies to include directives on the new codes if applicable
  • Follow up weekly with Coders and CDI specialists to discuss specific code sets/procedures that may require updating current Queries.
  • Ensure that you have a point person assigned to regularly check coding for quality

Physicians & Practitioners

  • Physicians must be vigilant and ensure that all documentation remains at a high level of specificity
  • For high impact surgeries and diagnoses, complete a 5-to 10-chart/ provider documentation review to ensure the documentation supports the highest level of specificity
  • Include the physicians and practitioners in the audit results and provide education on documentation opportunities that support the severity of illness of their patients.

Billers

  • Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill
  • There will likely be snafus related to reimbursements. How to create referrals and order services IS going to change. Effective October 1, 2016, Medicare will no longer accept unspecified codes for Part B. Have the POA include ways to prevent these accounts from being billed before a second level coding review can be done.

Outpatient

  • In the outpatient hospital side, queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing

Vendors

  • Do not forget to make sure that vendors are up to date and ready for the expanded codes on October 1, 2016.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

Nearterm specializes in the delivery of additional “horsepower” for implementing and supporting RCM activities and projects. These resources can work from remote locations and/or onsite, whatever hospital and the POA requires of them. Nearterm delivers only top notch talent;

  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support
  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Nearterm is a recognized authority in Revenue Cycle Management

 

Posted By: nearterm-admin

Are you Ready for the ICD-10 CM & PCS Deluge?

ICD-10 CM & PCS Deluge Medical Coding

NEARTERM WILL KEEP YOU DRY

On October 1st, of this year a deluge of over 5,000 new CM and PCS medical codes and other changes are coming your way!

  • CMS opens the dam to release the five-year hold on these codes and a one year reprieve for unspecified codes.
  • ICD-10 CM will have 1,943 new codes, 422 revisions & 305 deletions
  • ICD-10 PCS will have 3,651 new codes and 487 revisions

This represents a formidable challenge for healthcare organizations as we approach implementation of these changes. Your organization should be prepared with coder training, clinical documentation policies and new query updates already underway.

In addition, it is important to ascertain that providers are included in educational opportunities to review the new documentation requirements supporting Severity of Illness, Risk of Mortality and Medical Necessity.

There are many risks associated with the coming changes that hospital and physician organizations must consider. Here is a summary:

  • Susceptibility to denials and loss of payment if coding reported does not meet the expanded coding standards
  • Presence of staffing adequate to sustain DNFB targets – it will take additional time to navigate through coding pathways to refine coding practices.

If you would like extra horsepower as you prepare for what’s coming and/or perhaps additional support post-implementation, we are available to talk about how we can help. Our professional staff and medical coders are led by AHIMA Approved ICD-10 CM/PCS Trainers. Our coders and consultants undergo continuous education via coding clinics and “hands on” training aimed at new coding guidelines and compliant query opportunities.

We can get you ready for the deluge and we’ll keep you dry.

Learn More about our Medical Coding Services

Learn about our RCM Project Staffing Capabilities including for Coding

Ask the RCM Experts

Posted By: nearterm-admin

Medical Coding is Here to Stay

Medical Coders are Here to Stay

As a Medical Coding managed services provider, Nearterm sees a lot of growth in the future of medical coding.

The need for medical coders is expected to grow by 22% between 2012 and 2022, a rate much faster than average for other occupations. Source: CareerStep.

There are four main reasons for this.

  • ICD-10 & -11 Codes – The immediate reason are those healthcare organizations which are still behind in their coding for implementing ICD-10. The long term reason is that ICD-11, the revision to ICD-10, is due in 2018.  ICD-11 will be used with electronic health applications and information systems and no doubt medical coding will be needed.
  • CPT Codes – CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered rather than the diagnosis on the claim. ICD code sets also contain procedure codes but these are only used in the inpatient setting. CPT code updates occur more frequently than ICD updates. For example, CPT Category III codes are updated every six months.
  • The Affordable Care Act (ACA) – The ACA has made an impact on healthcare and healthcare jobs. The most obvious is the influx of Americans now eligible for medical care. That means more people having procedures that coders need to document.
  • The Human Factor – Human beings who possesses knowledge of procedure and diagnosis codes (as well as insurance regulations) will always be needed even with all the automation that is happening. It is far too easy for an automated system to incorrectly code what it picks up in a medical document. For example, if a document indicates a patient started to undergo a drug therapy protocol, but therapy was stopped due to developing medical conditions, the system will still likely generate a bill for the therapy. This can cause trouble for the insurance company and add one more difficulty to the patient’s list of worries.

 Medical Coding Managed Services

Nearterm offers managed medical coding services to healthcare organizations, including hospitals, clinics and physician practices. All of our medical coders are certified, vetted, professionally managed and domestic.

  • CCS – Certified Coding Specialist Managed
  • CIC – Certified Inpatient Coder
  • COC – Certified Outpatient Coder
  • CPC – Certified Professional Coder
  • CPC-P – Certified Professional Coder-Payer
  • RHIT – Registered Health Information Technologist
  • RHIA – Registered Health Information Administration

Nearterm’s Medical Coding Managed Services help healthcare organizations meet their coding needs as part of our overall 360 RCM Managed Services, including hospitals, clinics and physician practices. We offer a 360 solution from patient access to accounts receivable, including consulting and interim management.

See also: Certified HIM/Medical Coders: Remote or On-Site PDF

Are You Where You Should be at this time for ICD-10?
If you need help, Nearterm RCM Consultants can help with a gap analysis and an action plan. Ask A Nearterm Expert.

Posted By: nearterm-admin
Managed RCM
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