News & Analysis

April 25, 2017
Medicare Web

If my hospital submits an appeal to a payer and the payer upholds the denial, what next steps can we consider?

April 19, 2017
HIM Briefings

Payment reform is here to stay. Although reimbursement will continue to evolve over the next several years, it’s unlikely that payers, commercial or government, are going to abandon risk-based models and value-based purchasing and turn the clock back to fee-for-service and volume over value.

March 1, 2017
Briefings on APCs

As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims. 

February 21, 2017
Medicare Insider

This week's note is an excerpt from The Denials Management Training Handbook and discusses different types of claim denials.

February 9, 2017
Briefings on APCs

With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns. 

February 1, 2017
Medicare Insider

This week's note from the instructor discusses changes to the Medicare Appeals Process as set forth in the final rule published January 17, 2017.