The net result, according to the report, was that Medicare had overpaid the hospitals $914,128 for the 164 incorrectly coded claims over the two-year period. Extrapolated to all hospital claims that included the two codes, the OIG estimated that Medicare had overpaid hospitals approximately $1 billion in the aggregate.
The OIG and the Centers for Medicare & Medicaid Services (CMS) mutually agreed to reopen hospitals’ cost reports and to order its recovery audit contractors to initiate recoupment of overpayments to hospitals resulting from alleged “upcoding” of claims for patients suffering from severe malnutrition.
Now, more than ever, $1 billion is a direct and unwelcome hit on hospitals and health systems that haven’t optimized the quality of their coding by effectively monitoring their coders’ to compliance with applicable coding guidelines and requirements from CMS and other payers. This begs the question – what can you do about it when you have so many other things on your financial plate right now?
How to enhance your coding compliance and quality programs:
Every dollar counts as hospitals and health systems navigate through the pandemic and its operational and financial impacts. Accurate coding and reimbursement are vital to your hospital or health system’s success.
Engagement Is Healthcare’s New Currency
Ensuring that your coding fully and accurately reflects your patients’ diagnoses and the care they receive is foundational and non-negotiable for your hospital or health system to meet your revenue performance goals. For many hospitals and health systems that don’t have the bandwidth or know-how to establish best-in-class coding compliance and quality functions, bringing on a strategic partner with decades of coding experience, existing relationships with many payers and proven advanced technology to help optimize coding accuracy and efficiency could exponentially boost the effectiveness and success of your coding and billing functions. Conifer’s coding and compliance training, education, monitoring and audit programs can help improve your organization’s coding quality and outcomes.