Upcoding Crackdown: Federal Efforts Fail to Benefit Private Insurers

For more than a decade, taxpayer-funded health care programs have seen a steady uptick in higher-paying billing codes. Office visits, outpatient services, and emergency room care have all been billed at progressively higher reimbursement codes, raising fees by billions of dollars. Many providers contend the shift is the result of sicker patients coupled with the

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The Road to Optimal Opioid Prescription Length

The Centers for Disease Control and Prevention (CDC) estimates that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year. Most of that burden is related to workplace costs, such as lost productivity, prolonged time on disability, and increased work disability claim costs. To help combat this crisis, organizations

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Big Differences Between Three ICD-10 Coding Systems

Here are some interesting facts about ICD-10 that may not be commonly known. International Classification of Diseases (ICD) was created by the World Health Organization (WHO), which has served the healthcare community for over a century. While most industrialized countries moved to the ICD’s “tenth revision” – ICD-10 – 30 years ago (1983), the United

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If You Can’t Beat Them, Buy Them: Why Some Drug Costs Are Going Up

I have done some analysis on pharmacy costs for clients recently. During that time, I noticed an increase in the cost per prescription for some drugs. Our pharmacy partners have shown the same trend in their data. This upsurge made no sense to me. Many drugs are coming off of patent, meaning generics of those

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Variability in Surgical Costs – Bill Goes Viral

This article features a patient that posted their $55K appendectomy surgery bill online, and it makes some very interesting points. The University of California San Francisco researchers set out to find out how much an appendectomy cost in California. The price varied from $1,529 to $182,955. The “recovery room” was over $7K for 2 hours.

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How the $9.8 Billion Charge in Healthcare Can Get Better

It’s a stunning number — $9.8 billion dollars annually.  This represents how much hospital infections are estimated to be costing us, based on a study released by JAMA.  This is just the financial cost.  It does not take into account the human factor — the loss of life and limb associated with infections.  There are a couple

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