Inside Claim Denials for Nursing Homes, and Best Tips to Maximize Success Through MDS Coding
Nationwide, nursing homes are struggling financially. This problem is exacerbated by decreased revenue caused by improper coding. A recent article in Skilled Nursing News investigates the challenges nursing homes face with claim denials and offers strategies to enhance success through effective Minimum Data Set (MDS) coding.
The article Inside Claim Denials for Nursing Homes and Best Tips to Maximize Success Through MDS Coding states that incorrect coding causes annual revenue losses of $25,000 to $30,00 per nursing home. There are many factors behind this. Read the article to learn more and gain some tips to improve reimbursement.
This article falls under Financial and Technology in the Enterprise Risk Management (ERM) risk domains.
Financial
Decisions that affect the financial sustainability of the organization, access to capital or external financial ratings through business relationships or the timing and recognition of revenue and expenses make up this domain. Risks might include: capital structure, credit and interest rate fluctuations, foreign exchange, growth in programs and facilities, capital equipment, regulatory fines and penalties, budgetary performance, accounts receivable, days of cash on hand, capitation contracts, reimbursement rates, managed care contracts, revenue cycle/billing and collection.
Technology
This domain covers machines, hardware, equipment, devices, wearable technologies and tools, but can also include techniques, systems and methods of organization. Health care has seen an escalation in the use of technology for clinical diagnosis and treatment, training and education, information storage and retrieval, and asset preservation. Examples also include Electronic Health Records (EHR) and Meaningful Use, financial and billing systems, social media and cyber security; cyber risks can be significant.