News & Analysis

October 1, 2017
Briefings on APCs

Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.

September 28, 2017
Medicare Insider

This week's note reviews a recent Office of Inspector General report that found a 100% failure rate among reviewed claims. 

September 26, 2017
Medicare Insider

This week’s Medicare updates include an OPPS update; guidance on coding and billing date of service on professional claims; CMS’ efforts to support Puerto Rico and the U.S. Virgin Islands in the wake of Hurricane Maria; and more!

September 26, 2017
Medicare Web

The Office of Inspector General recently reviewed $51.6 million in Medicare Part B payments to acute care hospitals only to find that Medicare did not appropriately pay the hospitals for any of the reviewed outpatient services. In addition, beneficiaries were charged with $14.4 million in unnecessary deductibles and coinsurances for the hospital outpatient services.

September 25, 2017
Medicare Web

The fiscal year (FY) 2018 IPPS final rule included updates to payment rates and quality initiatives, as well as an ample amount of code changes and updates to ICD-10-PCS non-operating room (OR) to OR code designations.

September 25, 2017
Medicare Web

How can we help ensure all hospital departments involved in payer contracting are on the same page and understand the terms?

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