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News & Resources

risk-based auditing software, healthcare compliance, Medicare penalties

Healthcare Audits Highlight Benefits of Risk-Based Auditing Solutions

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March 28, 2018

Brookfield, WI March 27, 2018—It’s no secret that financial penalties for hospital-acquired infections or other injuries occurring within healthcare facilities can have disastrous consequences on a hospital’s bottom line. But some healthcare systems face these repercussions as a result of simple coding errors, not actual injuries to patients. This year (2018), 751 hospitals are facing Medicare payment cuts from the federal government.(1)

However, at least one hospital claims that medical coding errors—not actual patient injuries—are to blame for these penalties.(2) To lower risk as much as possible, healthcare systems should utilize risk-based auditing software solutions such as those offered by Fi-Med Management.  All hospitals facing disciplinary action stand to lose a significant amount of money from Medicare reimbursements over the next year. The federal government has announced a 1% cut to Medicare payments for each individual patient’s stay at the 751 facilities.(1) Hospitals on the list also face reductions in the amount of Medicare funds allocated for teaching medical residents and caring for low-income individuals.(1) A full 425 of the hospitals penalized in 2018 were also fined in 2017.(1)  Representatives from one hospital, Southern Maine Health Care, claim that employee coding errors are to blame for the financial penalties levied against the hospital this year. As a result of these coding errors, a medical condition was incorrectly added to the health records of several patients.(2)  

Adrian Velasquez, president, CEO and co-founder of Fi-Med, says, “This should be a huge wake-up call for healthcare systems around the country. It’s hard to understate the huge impact these financial penalties will have on the 751 hospitals, including those whose errors actually resulted from medical coding mistakes. Healthcare systems can’t let something as simple as a coding error result in the loss of large amounts of revenue.”  Risk-based auditing software, such as REVEAL/md, identifies compliance risks early so that corrective action can be taken before audits occur. Utilizing this type of solution is key to helping hospitals avoid costly mistakes.

About Fi-Med (www.fimed.com)   Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare technology company helping to disrupt the status quo of the increasing burden of government compliance for hospitals and hospital systems. As a leader in the healthcare support and management industry, Fi-Med provides billing, receivables management, credentialing, lockbox, and other financial management and reporting services to physicians, labs and medical centers nationwide. Its strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians and healthcare networks is the result of the technology tools that it has created: a 360-degree understanding of healthcare compliance, chronic care management, and revenue cycle management.   REVEAL/md is Fi-Med’s keystone product, empowering healthcare providers’ compliance departments to proactively manage physician part B audits of documentation and coding. For more information, visit www.fimed.com.  

About Adrian Velasquez, President, CEO and Co-founder   Armed with an extraordinarily successful career in the business of healthcare, Adrian E. Velasquez has successfully blazed new trails, taken risks and defied the odds, and in 1993, he partnered with Christine Krause and formed Fi-Med Management, Inc. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States.   Prior to his work at Fi-Med, Adrian worked with healthcare providers across the country, mastering all areas of business function and management for medical organizations of all sizes. His previous experience as a system administrator and healthcare consulting from New York to California formed the foundation that he harnesses today for Fi-Med clients.   Among his accolades, Adrian won the Small Business Person of the Year Award in 2007 for the state of Wisconsin and represented Wisconsin on the national stage.   Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med has grown exponentially over the last 24 years, becoming trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management.  

Sources: 1.    Medicare Penalizes Group of 751 Hospitals for Patient Injuries. Kaiser Health News. https://khn.org/news/medicare-penalizes-group-of-751-hospitals-for-patient-injuries/  
2.    Maine hospital attributes Medicare penalty to employee coding errors. Becker’s Hospital CFO Report. https://www.beckershospitalreview.com/finance/maine-hospital-attributes-medicare-penalty-to-employee...    

 

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