Author: hmicorp

Our consultant specialists will perform a comprehensive review of the home health documentation to validate the billed HIPPS code, HCPCS codes for visit disciplines (SN, PT, OT, SW, etc.), units, diagnoses codes, and billable supplies. A thorough review of the medical record documentation against the hospital final billed claim will confirm reporting accuracy. The key documents such as the OASIS, plan of care, and face-to-face certification are reviewed for completeness and accuracy in accordance with the episode of care. HMI is leading Home Health Revenue Cycle Management Companies, HHA Claim Review , Home Health Agency Revenue Cycle and Coding Servicing Companies.

Home Health Revenue Cycle Management | HHA Claims Review | Coding

Our consultant specialists will validate the billed HCPCS codes, origin and destination modifiers, provider arrangement modifiers (if applicable), loaded mileage, and verify the diagnoses codes reported to Medicare against the patient trip record.

Ground Ambulance Claims Review Services for Reimbursement

Our consultant specialists will validate Ambulatory Surgery Center (ASC) claim review & Audit for the CPT©/HCPCS and ICD-9-CM/ICD-10-CM diagnosis coding and modifier (if applicable) assignment of surgical services and drugs used during procedures performed at ASCs. The medical record documentation is reviewed against the ASC final billed claim to confirm reporting accuracy. The claim review will include an assessment of documentation quality for supporting medical necessity. HMI is leading Ambulatory Surgery Center Revenue Cycle Management Companies and ASC Coding Services and Ambulatory Surgery Center (ASC) Claims Review Companies.

Ambulatory Surgery Center Revenue Cycle Management | ASC Claims Review | Coding Nashville TN

Objective: To provide a helpline resource for the provider community to address coding and billing questions that may arise during day-to-day operations. HMI will answer questions using the most current coding guidelines and published CMS billing guidance.

Resource: Our consultant specialists will be available to answer questions via an e-mail service related, but not limited to the following:

• Chargemaster
• CPT©/HCPCS/UB revenue codes
• Modifier application
• OPPS billing
• CCI /MUE / Device and Procedure Edits
• Medical necessity
• Physician E/M billing

The current guidance utilized by HMI to respond to questions will be communicated via e-mail. This allows the individual to have access to these resources for future reference on related issues.

Warranty: Every effort will be made to respond to questions within a to 72 hour period and ensure the accuracy of the helpline responses. HMI’s helpline responses will be supported by the most current CMS guidelines available. HMI’s interpretation of the CMS guidelines may not always agree with the Client’s local MAC. When HMI has direct access to the MAC Part A or Part B guidelines, we will provide the most straightforward response available.

It is the client’s sole discretion to apply current guidelines to its coding and billing practices based on the information provided. HMI Provides Helpline Services for Medical Billing and Coding Online.

Ancillary Department and Emergency Department Charge Capture Audit and Coding Services. HMI currently provides charge capture and medical coding services for hospital Emergency Departments and other Ancillary Departments for facilities.  Our coding specialist will review the medical record and capture or validate the  appropriate CPT/HCPCS procedure codes and diagnosis. This includes both the professional and facility charges for services rendered. HMI Provides Charge Capture Audit and Medical Coding Services for Emergency Department and Ancillary Department Services.

Charge Capture & Coding for Emergency Department & Ancillary Services

Our consultant specialists will assist the hospital in the development and implementation of a facility resource-based criteria and charging tool for the purpose of objectively assigning ED visit levels and procedures. This service will include educational resources to staff relating to outpatient ED services for compliance with CMS rules and regulations. HMI Provides Emergency Department Education for Outpatient ED Facility E/M Services.

Our consultant specialist can provide case management reviews to assist physicians with the medical necessity criteria for observation and inpatient services. We also assist providers with the rebuttal process of carrier denials as well as RAC and MAC audits.

Our Nurse Auditors provide medical necessity reviews for ER physicians to ensure the patient meets the inpatient or outpatient medical necessity criterion as required by CMS.  We educate the physicians on the criterion elements to better equipment them as changes occur.

The hospital charge description master, or hospital chargemaster, communicates medical bills to payers and patients.
The hospital chargemaster plays a crucial role in revenue cycle management: it’s the heart of the healthcare revenue cycle. It’s the central point from which all billing gets sent to patients and insurers.
Organizations that fail to maintain the chargemaster face enormous problems. Poor chargemaster maintenance leads to revenue leakage. It can also lead to inaccuracies, non-competitive fees, and claim rejections.

Most people assume healthcare consulting benefits the organization – not necessarily the physicians within that organization. However, that’s not true. Physicians can and do benefit from healthcare consulting.
Physicians experience actionable improvements from healthcare consulting. These improvements can benefit the organization’s bottom line, improve patient care, and make it easier for physicians to do their job.
Today, we’re explaining some of the ways physicians can benefit from healthcare consulting whether running a small practice or working for a larger organization.

Charge Capture Reviews Identify Missed Revenue Opportunities

Healthcare consultants conduct charge capture reviews. You may not know how much you’re losing in possible reimbursement until you order a charge capture review.
Without accurate charge capture processes in place, potential reimbursement slips through the cracks. It can increase claim denial rates and waste money at multiple levels of an organization.
Many organizations struggle to identify charge capture errors – especially if they’re unfamiliar with the complex nature of charge cycles. As any healthcare consultant will tell you, charge capture is among the most destructive problems in healthcare reimbursement.
As a doctor at a hospital, charge capture review has less of a direct impact on you. As a physician at a private practice, however, charge capture reviews can add significant revenue to your business – you’re already performing this work, and you need to get paid for it. The success of your private practice depends on it.
A good healthcare consultant will conduct:
• Charge capture reviews
• Physician/provider claims reviews
• Review of office and inpatient E/M visits coded and billed
By targeting these areas of the organization, healthcare consultants can identify missed revenue opportunities – enhancing profitability for doctors, their practices, and their organizations.

Create a Better Environment for Support Staff

Support staff keep an organization running smoothly. When support staff are in a stressful or unhealthy environment, it impacts every level of an organization. Whether running a private practice or working for a hospital, keeping support staff productive is crucial.
Healthcare consultants optimize the administration of an organization. They assign support staff to their best possible roles. They analyze each person’s strengths and weaknesses, placing individuals in the best positions.
Many are surprised to discover how smoothly things operate with a few simple changes to administrative structure and support staff. Healthcare consultants know what works at other organizations, and they can recommend actionable changes for your organization to achieve real results.

Healthcare Consulting Provides Powerful Returns on Investment Year After Year

Hiring a healthcare consultant can provide a significant return on investment. You pay money today to discover how your organization can make more money for years into the future. If you’re running a small medical practice, this advice is priceless and provides a substantial return on investment.
Good healthcare consulting is worth every penny. You’re hiring someone to improve the profitability of your business. Yes, you pay the consultant today. But if you hire the right consultant, you get actionable advice that can add significant amounts to your bottom line year after year.

Enjoy Less Stress and Better Work Flow

Many doctors are leaving their private practices to work at hospitals. They like caring for patients – but they don’t like the behind-the-scenes paperwork and added stress.
A healthcare consultant can fix these issues. A good consultant manages these areas of your business, allowing you to enjoy less stress and better work flow.
With a good healthcare consultant, you can focus on what you do best, leaving all other work to the professionals.
As a physician at a hospital, these issues matter to you too. Many physicians at hospitals get caught up in paperwork and billing issues. They do work that has little to do with practicing medicine. It’s more administrative work and less medical work. That’s inefficient for the organization and frustrating for doctors.

Improve the Patient Experience and Reduce Wait Times

Medical consultants improve the patient experience at any practice or hospital. They handle the behind-the-scenes aspects of running a business, allowing you to maximize time spent with patients.
At a medical practice, this face-to-face time is crucial. It helps patients avoid feeling like a number. It makes them feel like you care about their health – which you should. You’re paying someone to focus on the business aspects of your business while you emphasize patient care.
After hiring a medical consultant, many physicians realize they have significantly more time to spend with patients. They can spend business hours meeting with patients instead of doing paperwork. You can limit the length of time patients spend in the waiting room.

Hire an HMI Healthcare Consultant Today

When you hire a healthcare consultant, you’re paying someone to make your business run more efficiently. The consultant provides actionable advice – or implements real solutions – that improve your business.
Whether running a small practice or working for a larger organization, physicians can benefit from healthcare consulting in countless ways.
Hire a healthcare consultant with decades of experience today by contacting HMI, LLC and discover actionable ways to improve your organization.

Healthcare organizations in the United States and around the world use the ICD-10 medical coding standard. Starting in 2022, however, organizations will switch to the ICD-11 standard.
ICD-11 has four times as many codes as ICD-10. That means new challenges for healthcare providers – and new problems with missed revenue, coding errors, and denied claims.
Keep reading to discover some of the significant changes in ICD-11 medical coding, including how your organization can prepare for the release of ICD-11.

What is ICD-11?

The World Health Organization has created the ICD-10 medical coding standard, which is currently in use in the United States and around the world. It’s the tenth version of the International Classification of Disease (ICD) codes.
In May 2019, WHO member states voted to implement the 11th version of that system: ICD-11. As healthcare changes and new diagnoses and treatments emerge, WHO regularly needs to update its coding system.
ICD-11 is scheduled to be implemented in all WHO member states, including the United States, in January 2022.
ICD-11 marks a significant increase in medical coding challenges. While ICD-10 had just 10,000 codes, ICD-11 has over 40,000.
Complicating matters further is that healthcare organizations in the United States use a modified version of ICD-10 that has 140,000+ codes, including 70,000 codes for diagnoses and 70,000+ codes for treatments.
In other words, ICD-11 is expected to introduce significant coding challenges for healthcare organizations in the United States.

Top 4 Ways to Prepare Your Healthcare Organization for ICD-11 Medical Coding

Healthcare organizations in the United States already struggle with ICD-10 coding challenges. Organizations lose revenue, sacrifice patient care, and face insurance denials, among other issues. Across the country, organizations lose billions to coding challenges every year.
With the launch of ICD-11, organizations will face new coding challenges. Smart healthcare organizations are already preparing. Here are some steps to help your organization get started.

1) Become familiar with new ICD-11 codes and chapters

ICD-11 has thousands of new codes and chapters. Many of these codes and chapters have not been seen in previous versions, and they’re totally unfamiliar even to experienced medical coders.
There’s a new code for work burnout, for example. Burnout appears in the ICD-11 section on problems related to employment or unemployment. The goal of adding this code is to make physician burnout a thing of the past.
ICD-11 defines physician burnout as:
• Feelings of energy depletion or exhaustion
• Increased mental distance or feelings of negativism or cynicism related to one’s job
• Reduced professional efficacy
Issues like time constraints, technology, and regulations increase the rate of physician burnout.
This code may seem straightforward to implement, but it’s more complicated than organizations realize. As AMA explains, organizations need to differentiate professional burnout from adjustment disorder, anxiety disorders, and mood disorders. Organizations also need to use this classification exclusively for professional burnout – not burnout in other areas of one’s life.
This is just one example of how ICD-11 will change the way organizations handle various challenges. Smart organizations are familiarizing themselves with these new codes and chapters today to avoid surprises in the future.

2) Update EHR and revenue cycle management software

To prepare for ICD-11, organizations need to ensure they have the latest versions of EHR and revenue cycle management software.
Inevitably, during the switch to ICD-11, some organizations will get stuck using older versions of software. This will introduce significant coding challenges and missed revenue opportunities, among many other issues.
Ensure your EHR and revenue cycle management software is updated and optimized to the new changes to ensure a smooth transition process.

3) Hire someone to oversee ICD-11 implementation

Some organizations are hiring leaders to oversee the implementation of ICD-11. These leaders self-assess the organization for coding discipline. They oversee training efforts in the leadup to January 2022. They lead educational initiatives for the new codes and challenges of ICD-11.
Ultimately, organizations that start preparing for ICD-11 today will be better equipped to handle these challenges than their competitors – and that means better organizational efficiency moving forward.

4) Hire a medical coding specialist

ICD-11 can be overwhelming – especially for organizations that lack medical coding leaders.
Many organizations have begun to hire medical coding specialists to prepare for the implementation of ICD-11.
A good medical coding specialist can optimize revenue cycle management, reduce coding errors, and enhance patient care, among other benefits. Even months before ICD-11 is implemented, medical coding specialists can recommend actionable changes that improve the efficiency of your organization.
Medical coding specialists are experts at ICD-10 and ICD-11. It’s their job to understand the unique challenges of ICD-11. They know the medical coding challenges faced by organizations, and they know the changes organizations need to make to optimize efficiency during the shift.

How HMI Helps with ICD-11 Medical Coding

Contact HMI, LLC to hire a contract medical coding specialist today.
HMI, LLC has a proven reputation for solving complex organizational challenges. We’ve helped organizations deal with ICD-10 coding challenges – and challenges related to the upcoming launch of ICD-11, among many other coding challenges.
Optimize your revenue cycle today by solving your organization’s coding challenges. Hire HMI, LLC and discover how your organization can improve and prepare for ICD-11 medical coding.