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THE COSTLY CASE OF
Poor Coding Quality
CRACKING THE CASE:
MANAGING THE COST OF CODING PROBLEMS
AN EXPENSIVE AILMENT
IN
1 5
Number of medical claims
processed inaccurately.
1
30%
Number of claims
denied or
ignored
on first submission.
2
PAINFUL SYMPTOMS
81%
Hospitals that received a complex denial
based on inpatient coding
in Q4 2015.
3
$5,427
Average dollar value of each
complex denial.
4
COST OF DENIALS TO HOSPITALS:
48%
spent
$10,000+
managing
the RAC process
29%
$25,000+
spent
7%
spent
$100,000+
5
LINGERING SIDE EFFECTS
>87%
Claims appealed to the Administrative Law Judge
that take
longer than the statutory limit
of 90 days
to provide a determination.
6
31%
All cumulative claims appealed
that
still sit in the appeals process.
7
TRAINING:
155,000
ICD-10 codes
18,000
ICD-9 codes
EXPERIENCE:
64%
of medical
coders with
<4 years'
experience.
8
NEED:
By 2024,
demand for
coders will increase
15%
— faster than the average for all occupations.
9
ROOT PROBLEMS
THE DIAGNOSIS
Coding impacts every healthcare organization's bottom line.
ACCURACY =
EFFICIENCY AND CAPTURED REVENUE
INACCURACY =
INEFFICIENCY AND LOST REVENUE
1. Diane Suchetka, The Plain Dealer, “AMA says large health insurers are processing claims faster, more accurately and with fewer denials,” June 17, 2013, http://www.cleveland.com/healthcare-savings/index.ssf/2013/06/ama_says_large_health_insurers.html
2. Manny Oliverez, Capture Billing, “Proper Medical Billing and Coding is Important for Correct Insurance Payments,” http://www.capturebilling.com/health-insurance-companies-process-1-in-5-claims-wrong/
3. David Doyle, HBMA Billing, “Where Your Clients Might Be Losing Money In Their Practices,” January/February 2013, http://www.hbma.org/news/public-news/n_where-your-clients-might-be-losing-money-in-their-practices
4. American Hospital Association, “Exploring the Impact of the RAC Program on Hospitals Nationwide,” March 2, 2016, http://www.aha.org/content/16/15q4ractracresults.pdf
5. American Hospital Association, “Exploring the Impact of the RAC Program on Hospitals Nationwide,” March 2, 2016, http://www.aha.org/content/16/15q4ractracresults.pdf
6. American Hospital Association, “Exploring the Impact of the RAC Program on Hospitals Nationwide,” March 2, 2016, http://www.aha.org/content/16/15q4ractracresults.pdf
7. American Hospital Association, “Exploring the Impact of the RAC Program on Hospitals Nationwide,” March 2, 2016, http://www.aha.org/content/16/15q4ractracresults.pdf
8. Payscale Human Capital, “Medical Coder Salary,” May 4, 2017, http://www.payscale.com/research/US/Job=Medical_Coder/Hourly_Rate
9. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, “Medical Records and Health Information Technicians,” https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm
THE PRESCRIPTION
A trusted vendor like Ciox offers coding services, auditing and education that can help maintain your coding staffing levels and enhance coder quality.
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