Implementing a denial avoidance initiative can help facilities and health systems realize lost revenue, achieve cost savings, and improve an organization’s financial performance.
Payers rely heavily on the use of data and data analytics to manage their risk. Follow these tips for using payer guidelines to understand what they’re looking for and how to improve documentation.
Many HIM directors find that managing the coding team requires a different type of focus than other functions within the department. This may be true because coding professionals have advanced education, prefer a quiet work environment, and require less direction.
In the April 2018 OPPS update transmittal, CMS announced new HCPCS code C9749 (repair of nasal vestibular lateral wall stenosis with implant[s]), effective April 1, 2018.
Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.
The Government Accountability Office (GAO) has urged CMS to renew prior authorization programs slated to expire. The GAO made its case for continuing the programs in a report released in April, arguing that the programs reduced spending by nearly $2 billion since 2012.
