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Saisystems Health Blog

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How Downcoding Decreases Your Dollars

By Ramesh Leelasankar and Soundar Raja, Delivery Managers

As a provider, you may have struggled to evaluate the benefits of downcoding. Believe it or not, CMS data reveals that some physicians are coding four levels below to avoid payor audits. Comprehensive Error Rate Testing (CERT) reports that physicians lose more than $1 billion in revenue every year due to this practice.

So, is downcoding worth the risk?

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Caregiver Burnout

By: Samantha Manns, Marketing Specialist

Before you get too far into this post, give yourself a pat on the back if you are a caregiver. Go ahead, we’ll wait.

Did you have any difficulty rewarding yourself? If so, you’re not alone. If you are not a caregiver, I’m sure there’s one in your life that deserves accolades, but is truly too busy to stop and be rewarded.

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New Year, Familiar Challenges

By: Allison Scheier, Client Relationship Manager

The start of the New Year can be a tough time for medical practices. Patients are sicker (I’m looking at you, flu season), the quality reporting period begins anew January 1st, and deductibles reset to zero. Resetting deductibles weren’t worrisome a decade ago when overall patient responsibility was low, but with the popularity of high deductible insurance plans rising, patients carry an ever increasing amount of financial responsibility.

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Types of Care Managers

By Sheryl Riley, RN, OCN, CMCN

Believe it or not, as a health plan member you have the right to request and work with a care manager. Most health plans have both, even hospitals and large practices. However, while they are a great resource, not all care managers are nurses, and that can make a difference for you health. Today, various titles for members of a care team are used interchangeably to describe different types of professionals like:

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