Guidelines have been released by The Centers for Medicare & Medicaid Services (CMS) to ensure that every patient’s health record contains quality documentation. The general principles which have been laid down by CMS for medical record documentation with regards to reporting of medical and surgical services for Medicare payment are as given below:
According to CMS, Medical records should satisfy the following criteria to be considered as complete and legible
The Centers for Medicare & Medicaid Services (CMS) has finalized new rules allowing the sharing of analyses and data between providers, employers, and others. The new rules will help in more informed decisions about care delivery and quality improvement.
The rules seek to enhance the current qualified entity program to allow innovative use of Medicare data for non-public quality improvement and care delivery efforts while ensuring the privacy and security of beneficiary information. The rules will help to abide by the Affordable Care Act’s Qualified Entity Program and are required by the Medicare Access and CHIP Reauthorization Act (MACRA). The new rules will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care.
Qualified entities can also provide or sell claims data to providers and suppliers such as doctors, nurses, and skilled nursing facilities. The rule includes strict privacy and security requirements for all entities receiving patient identifiable and scrubbed analyses or data. If entities receive identifiable data, they must use the stringent requirements of HIPAA Privacy and Security Rules.
The United States’ healthcare industry transitioned to ICD-10, increasing the number of diagnostic codes from 13,000 to 68,000 after three delays and much industry opposition. The transition was expected to disrupt providers’ finances. However, new data from the report shows the conversion minimally impacted cash collections, initial denial rates and days in accounts receivable, according to a report from public accounting, consulting and technology firm Crowe Horwath.
Crowe Revenue Cycle Analytics compiles and organizes a daily feed of transactional-level data from the patient accounting systems of nearly 600 hospitals. These reports outline findings based on an assessment of key performance indicators related to billing and coding, accounts receivable and denials.
Findings of the report are as detailed below:
The University of Missouri has agreed to pay the federal government $2.2 million to settle a claim that their health care program physicians committed fraud. The program is part of the University of Missouri Health System. It has made a five-year corporate integrity agreement with the Office of Inspector General for the U.S. Department of Health and Human Services.
The program was accused of violating the False Claims Act by submitting claims for radiology services to federal programs such as Medicare and Medicaid, and maintaining that radiology images had been reviewed by physicians. Federal health care programs only pay when a physician is involved with the review. A federal investigation had found that physicians had not reviewed the radiology images. Federal officials claim the reviews were conducted by resident physicians.
The university is also repaying the federal government about $3 million for unrelated billing issues discovered during the radiology review investigation. That payment is related to a series of overpayments from 2001 to 2013, in which the health system did not properly bill the government for two specific tests and treatments.
MD2U Holding Company, including its related companies and individually named owners has agreed that they violated the federal False Claims Act by knowingly submitting false medical claims to Medicare and other government health care programs, altering records to support false claims, and providing services that were medically unnecessary.
Due to violation the company has agreed to pay millions to resolve the government lawsuit filed against them. MD2U utilized an electronic medical records (EMR) system that permitted to easily electronically cut copy and paste medical notes from prior visits. The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U were performing a significant amount of work during their patient encounters when, in fact, they were not.
If the documentation was deficient to bill the highest level code, MD2U would direct the concern department to go back and change the medical record after the encounter had occurred to falsely show that more work was performed during the visit in order to support the highest level billing.
Medical Coding Newsletter
Mr Vinod Arora, Principal Advisor, IGMPI
Placement testimonials: Our alumni are working with Fortune 500 and global Pharmaceutical, Food and healthcare giants like