Posts tagged ‘RAC’

Coding in the Time of EHRs

While developing OpNote, we’ve encountered some push back and criticism from the various organizations. But the most pointed barbs of criticism have come from medical coders at the hospitals and ambulatory surgery centers (ASCs). Based on the way that we have constructed OpNote, physicians automatically capture the Current Procedural Terminology (CPT) codes and the International Classification of Diseases (ICD) codes. While the coding is evident – and users can search by codes, if so desired – surgeons are not forced to navigate through codes, but instead they find the proper procedure and diagnosis by using words and common phrases.

Some coders have balked at the idea of doctors coding their own procedure. There are nuances to the coding structures that could easily be missed by those who have not made it the primary focus of their jobs to know how codes are generated or what factors in the report lead to changes in the coding process. The number of physicians that confidently know medical coding is increasing, but there will always be various subtleties to coding that really only come from education and experience. However – that doesn’t mean there isn’t room for improvement.
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May 27, 2010 at 10:01 am Leave a comment

The RAC is Connecting the Dots: Are You Ready?

Did you ever wonder about the insanity of separate billing for the hospital and a hospital-based physician?  The requirement was put in place to simplify Medicare’s accounting system and keep track of which trust fund the payments came from.  Separate billing is demonstrably redundant, wasteful and confusing to patients – and recently CMS announced plans that will likely add insult to injury.

RAC (recovery audit contractors) efforts have been expanded into complex case reviews.  Hospitals in RAC region C (Connolly Healthcare) are starting to compare inpatient DRG assignments to physicians’ reports, especially in the area of surgery.  Although the patient, the procedure and the diagnosis are the same in actuality, there is little coordination of billing and coding between the surgeon and the hospital to ensure that they are billed and coded similarly. Coding and billing are independent processes for each party. This is the weakness that the RAC will be attempting to exploit.

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January 29, 2010 at 12:00 pm Leave a comment


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