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One major reason for all the inefficiency in American healthcare is poor medical coding.
Behavioral Health, Interoperability and eConsent: Meeting the Demands of CMS Final Rule Compliance
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
Stephen Parente, director of the University of Minnesota’s Medical Industry Leadership Institute, has estimated that 30-40 percent of all medical bills have errors, according to data supplied by AmeriVeri CR, a medical code verification company based in Greenwood, Indiana.
The Denver Post reported in 2010 that medical billing errors and fraud account for $68 billion in waste annually. That’s about 3 percent of all health spending in this country.
To address this, AmeriVeri has introduced a “prepayment” tool to help hospitals and medical practices head off billing errors. “We identify code errors before payment of the claim is made rather than as an audit after payment. We verify code accuracy on the line level so payment is not made on lines containing errors,” CEO Jim Baughman said in an email.
AmeriVeri said that its technology has been shown to capture 3 to 4 errors per 100 lines of code and that it can scan 1 million claims for code errors in 25 minutes. Without this error correction, the company said, even patient medical records might be inaccurate.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“Medical codes are the core data used in every aspect of modern healthcare – every provider, payer and facility relies on them,” said Martin Amberger, vice president of operations at AmeriVeri. “The accuracy of codes therefore has a direct relationship with overall quality of care and the effectiveness of the system as a whole.”
