A recent analysis of patient financial transactions from more than 800 hospitals noted performance disparities among managed care payers for revenue cycle key performance indicators where accounts receivable and denials are concerned.
Case managers provide value across many healthcare settings and specialties. In particular, their interpersonal and communication skills can prove invaluable in the area of workers’ compensation, according to CMSA Today.
Handling requests for information from law enforcement can throw staff for a loop. Most staff are aware of their organization’s policies and the basic HIPAA requirements for disclosing patient information to family members, friends, and other individuals such as legal guardians. But handling requests from law enforcement officials can be a different matter.
CMS will cut payments for certain services perfromed by off-campus provider based departments (PBD) by 20%, according to the 2018 OPPS final rule. The pay cut will affect PBDs established after November 2, 2015, or which do not meet other exemptions.
Claims denials by commercial and government payers are continuing. A chief reason for this trend is insufficient documentation to support patient status determinations: in other words, why a patient is an inpatient or outpatient. Here’s why documentation is critical to utilization review.
Q: Ever since we moved to an electronic health record (EHR), our HIM department has noticed some physicians copying and pasting information from previous records. How do we know when this is allowed or when we can query the provider to clarify?
The 2018 OPPS final rule, published in the Federal Register on November 13, has two changes that could affect case managers—the removal of the total knee replacement from the inpatient-only list and cuts to payments for drugs purchased through the 340B drug discount program.