An “Easy” Button for
Healthcare
As tax time looms around the corner, we all relish getting a
refund and dread having to pay anything additional. We all fear getting audited
down the line and maybe even having to come up with funds to pay the IRS if any
errors were discovered in that audit. Imagine having to pay large amounts of
money back that you probably do not have in easy reach but that is exactly what
is happening to healthcare providers.
Problem
In another OIG finding
reported by Joe Carlson of ModernHealthcare.com, “If a hospital discovers that a
nurse practitioner had been receiving payments at the full physician Medicare
rate instead of the discounted 85% rate that most nurses receive, that facility
will now have to go back and audit five years' worth of billings for which that
nurse's services were billed, instead of just three.”2
In another move to curb overpayments and scrutinize claims
further, CMS and private payers recently announced a fraud prevention
partnership designed to share claims information and best practices in an
effort to improve detection and prevent fraudulent billing across payers. The
membership include CMS, the Justice Department, Blue Cross and Blue Shield Association,
eight private payers and the Coalition Against Insurance Fraud.3
Imagine that you are now one
of those providers getting these letters for huge overpayments – funds that
will be taken out of your future A/R impacting your business financially in
both re-payments and re-education of coding and billing staff not to mention
scrambling to find a way to catch these types of claims before they are
submitted for payment. These claim errors can easily viewed as fraud if a
provider does not police themselves.
Or perhaps you are the payer
contractor that has paid these claims and now are faced with having to perform
a forensic audit of your own and designing system edits to prevent future
overpayments. Where do you start and how do you prevent this or any other
similar situation from occurring? Is there an “Easy” button out there for
healthcare billing errors?
Solution
An exciting and revolutionary way to
utilize and audit your own data whether it resides in a practice management
system, electronic healthcare record or revenue cycle management system is
finally here. Context4 Healthcare has developed a new tool to help
payers, providers, billers, coders and auditors with the way to view data from anywhere
in your own system, compare it to current compliance rules and if acceptable to
change the information before it is submitted for reimbursement, with a click
of a button. No integration is necessary. It’s quick and easy and all done
online, and can be used anywhere in your workflow. Let Context4
Healthcare show you how easy it is to take data in one system and be able to
review it for errors and overpayments seamlessly without messy integration.
Call us today and let us show you how we can help you be successful with your
auditing, billing and editing challenges.
3.
http://www.partbnews.com January 21 2013 Vol. 27 Issue 3
