Posts tagged ‘downcoding’

March 26, 2012

OIG finds $432 million+ in HHA claims issues

The HHS Office of the Inspector General conducted a study looking at home health claims from 2002-2008 and found that$432 million in Medicare monies were inappropriately paid either because medical necessity was not established or coding was inaccurate. Millions more dollars were lost to CMS or HHAs because of upcoding or downcoding.

The number of HHAs grew from 7,052 to 9,801, and increase of 39 percent. Medicare spending on home health increased 84 percent from $8.5 billion in 2000 to $15.7 billion in 2007. The sharp rise in payments created the push to investigate payments.

HHS reviewed the claims of almost 500 beneficiaries to see whether Medicare coverage requirements were met.

The office found that 22 percent of claims were in error because services were not medically necessary or claims were coded inaccurately, resulting in $432 million in improper Medicare payments. Also, HHAs upcoded about 10 percent ($278 million) of claims and downcoded about 10 percent ($184 million) of claims.

OIG believes it needs to investigate more to determine what services are met and what potential for fraud is involved.

Read the complete report.

December 7, 2010

Coding education in Vegas does not stay in Vegas!

Go back to your agency as a coder or administrator and share the information you learned at the Coding and Regulatory Symposium! Come to my two-day class focusing on recent coding changes, especially those impacting wounds and therapy, with a focus on regulations and how these changes impact the bottom-line of agencies.

January 27-28, 2011, Monte Carlo Resort and Casino in Las Vegas, Nevada
9:00AM -4:15PM each day

This class is appropriate for all levels of coders, plus administrators who want to learn more about how coding impacts revenues and operations.

Agenda Day 1

Morning focus: Regulatory Issues
9:00‐10:00  How Coding and OASIS Add to Your Case Mix Score
10:00‐10:45  Myths and Truths that Impact Therapy Coding
10:45‐11:00 Break
11:00‐11:30 Common Errors Impacting Your Payment and Outcomes
11:30‐12:00 ICD‐10 and the 2011 Change to the 5010 Format
12:00‐1:00 Lunch
Afternoon focus: Applying regulatory education to coding
1:00‐2:00  Sequencing and Coding Guidelines
2:00‐2:45  Interactive Coding Session
2:45‐3:00 Break
3:00‐4:15 Interactive Coding Session (continued)
4:15  Adjournment
Agenda Day 2
9:00‐10:30 Wound Care Coding: All Wrapped Up
10:30‐10:45 Break
10:45‐12:00 Interactive Coding Session
12:00‐1:00 Lunch
1:00‐2:30 How Jan. 1 PPS Changes Impact your Operations
2:30‐2:45 Break
2:45‐3:30 How to Support Your Coding and Appeal Downcoding
3:30‐4:15 Facts and Forward Thinking about ICD‐10‐CM and ICD‐10‐PCS
4:15 Adjournment

Coming to Vegas?

$49 a night! That’s the price we have arranged (plus $12.95 for a resort fee) for each night at the Monte Carlo!!

Looking for a registration form?

December 1, 2010

Come to the Home Care Coding and Regulatory Symposium

On Jan. 27-28, I will hold a two-day seminar on coding and its interactions with regulatory, OASIS and therapy issues. This is just a teaser … more to come soon!

It’s $385 for the first attendee; $350 for more than one attendee from your organization. And a quick note that it’s in Vegas at the Monte Carlo, and we’ve gotten rooms for less than $50 a night! Cheap hotel and great education!

Home Care Coding and Regulatory Symposium

Something for Everyone! Because coding affects or is affected by OASIS and regulatory changes, we focus on how the pieces work together, especially with recently enacted, and upcoming changes. The most current issues:

  • How 2011 PPS Changes Impact your Operations
  • Additional Changes Impacting Home Care in April 2011
  • How Coding and OASIS Add to Your Case Mix Score
  • How Coding Errors Impact your Payment and Outcomes
  • 2011 Change to the 5010 Format and ICD-10-CM Forward Thinking
  • Interactive Coding Sessions on both days—Send your most complex scenarios!
  • Wound Care Coding–All Wrapped Up
  • Myths and Truths that Impact Therapy Coding
  • How to Support Your Coding and Appeal Downcoding

More to come here and at www.selmanholman.com!