Revenue Cycle News and Analysis

January 14, 2021
Medicare Insider

This week's note from the instructor explains how the Most Favored Nation model will affect billing and payment for Part B drugs.

January 19, 2021
Medicare Web

South County Health Alliance (SCHA), a health plan based out of Owatonna, Minnesota, reported a security breach on December 31 affecting 66,874 individuals, according to the Office for Civil Rights (OCR) breach report.

January 18, 2021
Briefings on HIPAA

Ever run into a vendor who claims to be a conduit versus a business associate (BA)? It happens all too often, in my experience. Here’s the problem: The conduit exception is a narrow one. If you’re storing protected health information (PHI), even encrypted PHI where you don’t have the encryption key, you’re a BA. Once you sign the business associate agreement (BAA), it applies to you.

January 18, 2021
Medicare Web

Q: Acute respiratory failure is consistently one of our top denied diagnoses. We've tried to address common documentation errors through education but are still seeing issues. How can our CDI staff and coders create more effective queries for this condition?

January 18, 2021
Medicare Web

The American Medical Association (AMA) recently released a free tool to help clinical staff determine appropriate CPT® and HCPCS Level II coding for COVID-19 vaccines and vaccine administration.

January 15, 2021
Case Management Monthly

Are your patients skipping needed appointments? A research letter titled Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the U.S., published in November by JAMA Internal Medicine, hints that this may be the case.

January 15, 2021
Medicare Web

Q: What is an ectopic pregnancy and how would we report this condition in ICD-10-CM?

January 14, 2021
Medicare Web

Q: What type of activity must be audited to comply with the HIPAA requirement to audit electronic medical record (EMR) activity? Does this include every action a user takes within a record and the length of time a user spends in a record?

January 14, 2021
Medicare Insider

This week's note from the instructor explains how the Most Favored Nation model will affect billing and payment for Part B drugs.

January 13, 2021
HIM Briefings

Organizations continue to struggle with denials for conditions such as sepsis and pneumonia. Review your processes and then apply these expert tips to help turn the tide.

January 13, 2021
Medicare Insider

This week’s Medicare updates include payment adjustment information from the Consolidated Appropriations Act, revisions to information in the COVID-19 billing FAQ document, a notice of funding opportunity for development of radiology quality measures, and more! 

January 13, 2021
Medicare Web

UnitedHealthcare (UHC) is suspending certain prior authorization requirements for in-network hospitals and skilled nursing facilities through January 31.

January 13, 2021
Medicare Web

Q: Throughout the novel coronavirus (COVID-19) pandemic, case managers have faced many challenges when trying to find placements for patients who need to transfer from the hospital to a lower level of care, such as a skilled nursing facility (SNF). As we enter 2021, what challenges will persist and how can case managers work to overcome them?