Various analyses must be conducted to maintain compliance, assist with charge capture, solve account edits, and review any possible coding trends or issues that may cause claim delays, denials, or unnecessary rework. Learn how to effectively leverage this data to improve processes and protect revenue.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC, defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
A report released last month by the American Hospital Association (AHA), called Commercial Health Plans’ Policies Compromise Patient Safety and Raise Costs, found that not only is the cost of private health insurance raising affordability issues for American consumers, but policies, such as prior authorization requirements, may increasingly be putting patients at risk and driving up hospital administrative costs.
Revenue erosion and denials are often easily prevented, but simple errors may evade traditional, reactive denials management processes. Apply these tips to reduce and prevent common denials due to medical necessity, the three-day payment window, and more.
The 3-day payment rule is known to coders by various names such as the 72-hour rule, the 3-day payment window, or MS-DRG window policy. Kimberly Lee M.Ed., RHIA, CCS-P, describes how to navigate the rule’s nuances for billing purposes.
