News & Analysis

April 9, 2018
Medicare Web

What strategies would you recommend for building an effective denials management team?

March 28, 2018
Medicare Web

CMS instructed Medicare Administrative Contractors (MAC) to review previously denied 2018 outpatient therapy claims reported with modifier -KX. However, because MACs might not automatically review all denied therapy claims, providers will need to initiate the process.

March 7, 2018
Medicare Web

Incorrect inpatient rehabilitation facility (IRF) claims led to $444,458 in overpayments at Memorial University Medical Center, a Savannah, Georgia-based hospital, according to a recent Office of Inspector General audit report. IRF billing compliance has been on the OIG’s radar for several years, and Medicare Administrative Contractors and supplemental medical review contractors have been placing these claims under increased scrutiny.

March 1, 2018
Briefings on APCs

In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.

February 28, 2018
Medicare Insider

This week’s Medicare updates include two compliance reviews from the Office of Inspector General, an enforcement instruction on supervision requirements for outpatient therapy, clarification of instructions for medical reviews of inpatient rehabilitation facility claims, and more! 

February 21, 2018
HIM Briefings

Educating patient access staff plays a key role in keeping denial rates low.