News & Analysis

January 11, 2021
Medicare Web

Q: We're seeing a significant increase in pre-payment audit activity. How can we adapt our audit and denial management processes to cope with this shift?

January 1, 2021
Briefings on APCs

Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.

December 30, 2020
HIM Briefings

Use this sample billing and charge audit procedure as a template for your organization.

December 3, 2020
Medicare Web

The 2021 OPPS final rule, released December 2, doesn’t pack many surprises, with CMS generally finalizing most policies as proposed or choosing to continue with current policies. This should aid hospitals required to implement many of its policies in just a few short weeks due to the pandemic-disrupted rulemaking cycle.

December 2, 2020
HIM Briefings

Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. Use these tips to create a multidisciplinary strategy that gives you a clear view into processes.

December 1, 2020
Briefings on APCs

CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.