Optum360 coding books logo
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

View Article Archive

To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:

Medical Coding News Archives

Nothing is certain except death and taxes…and auditing!

January 18, 2017:

Back in 1789, Benjamin Franklin remarked that, “In this world nothing can be said to be certain, except death and taxes.” But, in the 21st century, there is another certainty – especially for providers of health care – and that is the use of auditing by payers and providers to examine the validity of medical claims. What makes auditing a certainty is the growth of health care expenditures in the last 25 years, and the few ways in which those costs can be controlled.

By most estimates, health care costs will consume 20 percent of the Gross Domestic Product (GDP) in 2017, or very soon thereafter. At this historically high level, expenditures for health care lower wages and make U.S. companies less competitive internationally. Simply put, at 20 percent of GDP, health care crowds out other sectors of the economy.

Sure, cutting payments to hospitals and physicians can yield immediate and significant results, but plans for draconian cuts will be opposed by the members of Congress representing health care workers. A much more equitable approach to controlling costs is to eliminate unnecessary “waste” that drives up health care costs. But, eliminating waste means examining claims for medical necessity and administrative compliance, which includes a wide range of edit points that plague provider claims today. In short, auditing isn’t going away – especially in an environment where costs of care are a threat to the U.S. economy.

Waste in the U.S. health care system

How much can auditing cut from the U.S. health care system? One recent estimate* says waste makes up $1.2 trillion, or about 37 percent of total U.S. health care costs – nearly all of which can be addressed through processes that involve review of medical claims.

For information about how to audit – and survive audits – check out the 2017 Auditors’ Desk Reference.

*Journal of the American Medical Association, March 14, 2012, Eliminating Waste in US Health Care.


Sign in to
Your Account
Forgot your username?
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:

What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog