Health Care Finance Articles Review Summaries, Article Review Example

Walked Into a Lamppost? Hurt While Crocheting? Help is on the Way. New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps. Anna Wilde Mathews. Wall Street Journal 13 September 2011.

http://online.wsj.com/news/articles/SB10001424053111904103404576560742746021106?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424053111904103404576560742746021106.html

An article from the Wall Street Journal addresses the implementation of the ICD-10 coding system to classify every diagnosis and procedure in great detail. According to the article, some of the codes are unwelcome and even derogatory in nature, thereby creating challenges for medical billers and for patients. Furthermore, the system appears to have many unnecessary codes that do not represent realistic and common diagnoses. The complexity of the ICD-10 system is challenging for physicians and unwelcome in some respects because the number of codes for a single injury may number in the hundreds if not thousands. Nonetheless, some companies have taken advantage of the coding nightmares for their own financial gain by developing videos and websites to poke fun at the system.

The mandate to implement ICD-10 coding occurred in late 2013, and the cost of this implementation is significant for many organizations, perhaps with minimal benefits. Nonetheless, healthcare providers must be able to implement the system as part of their daily business practice so that they are able to compete with other facilities to attract patients and expand reimbursement structures. This coding system is challenging for obvious reasons; however, it is a necessary component of the future of healthcare billing practices and must be encouraged and adopted without hesitation to make the appropriate diagnoses to receive maximum reimbursements from insurance companies.

I believe that although the ICD-10 system is cumbersome and far too detailed, healthcare organizations must go along with the change and upgrade their existing system to implement the system because simply put, their reimbursement infrastructure and financial gain depends on it. The cost of this upgrade may be significant, yet the financial rewards will be realized over time when all billing processes and coding systems are current.

The Real Promise of ‘Accountable Care’: New ACOs reward health providers for outcomes, not for cost cutting. Elliott Fisher, Mark McClellan, and Stephen Shortell. The Wall Street Journal. 4 March 2013.

http://online.wsj.com/news/articles/SB10001424127887323978104578332862835152872

This article from The Wall Street Journal addresses the significance of accountable care organizations (ACOs) in modern healthcare systems and the need to achieve quality performance measures. This is a critical component of cost savings and the reduction of unnecessary procedures that are not required under this model. Some of these organizations have well-established and successful platforms; however, others represent new collaborations, many of which are physician-led in order to improve quality of care and to provide a framework for reducing costs effectively.

For these organizations, the cost effective elements that are most relevant demonstrate the importance of coordinated care that improves quality and minimizes errors in diagnoses and treatments. ACOs represent a newer trend in healthcare practice settings that require total physician input and guidance in order to achieve maximum cost savings by performing only those procedures that are deemed necessary and that will have a positive impact on patient care. These elements are essential to the discovery of areas where waste is common and limits quality of care. Nonetheless, it is unlikely that all ACOs will be successful, as other reforms throughout the healthcare system are necessary to enable these trends to continue throughout the healthcare system in the United States.

This article is important because it provides a summary of ACOs and the development of this trend in healthcare practice. With a significant focus on quality, organizations must be able to demonstrate their knowledge and expertise of health issues so that they are able to maximize of their cost effectiveness on many different levels. This will also enable their patients to achieve optimal quality of care and treatment from their physicians. The process, however, is not without its challenges and must be considered in the context of its ability to be successful in treating patients with cost effective measures and optimal quality at all times.

Feds must prioritize EHR billing fraud, watchdogs say. Ken Terry. Information Week. 13 January 2014. http://www.informationweek.com/healthcare/electronic-health-records/feds-must-prioritize-ehr-billing-fraud-watchdogs-say/d/d-id/1113403

This article from Information Week addresses the relevance of fraud associated with billing in today’s healthcare practices where electronic health records are in place. There is a significant level of fraud as detected by the Centers for Medicare and Medicaid Services; therefore, additional strategies must be considered that will work to reduce fraud within healthcare organizations. As a result, the CMS must consider its own strategies more carefully so that they are able to recognize different types of fraud and its impact on billing and reimbursement strategies. Fraud is identified in a number of different ways, such as documentation errors that are intentional to distract payers from actual charges. This level of fraud is common and occurs throughout healthcare practice in different ways so that organizations receive maximum reimbursement, even if the diagnoses and subsequent procedures or tests that are ordered do not align with these claims. Recovery Audit Contractors (RACs) demonstrate that when reviewing these charges, there is little oversight and auditing of these claims, thereby contributing to the level of waste and fraud that exists. Therefore, it is suggested that a comprehensive system of evaluating data must be conducted using an audit log system that captures any falsified or suspect data before reimbursements are made.

This article supports the development of new advancements for RACs so that their roles and responsibilities as auditors are expanded and optimized. This role is significant because it reflects the importance of new strategies to ensure that organizations do not commit fraud, and if they are suspected of fraud, the appropriate disciplinary action is taken. I believe that the actions taken by RAC organizations are of critical importance in reducing waste and improving outcomes for healthcare organizations with respect to healthcare quality and cost effectiveness.

References

Fisher, E., McClellan, M., and Shortell, S. (2013). The Real Promise of ‘Accountable Care’:

New ACOs reward health providers for outcomes, not for cost cutting. The Wall Street Joiurnal, 4 March 2013. Retrieved from http://online.wsj.com/news/articles/SB10001424127887323978104578332862835152872

Mathews, A.W. (2011). Walked Into a Lamppost? Hurt While Crocheting? Help is on the Way. New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps. The Wall Street Journal, 13 September 2011. Retrieved from http://online.wsj.com/news/articles/SB10001424053111904103404576560742746021106?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424053111904103404576560742746021106.html

Terry, Ken (2014). Feds must prioritize EHR billing fraud, watchdogs say. Information Week, 13 January 2014. Retrieved from http://www.informationweek.com/healthcare/electronic-health-records/feds-must-prioritize-ehr-billing-fraud-watchdogs-say/d/d-id/1113403