Auditing and monitoring

Use this sample billing and charge audit procedure as a template for your organization.

CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.

The 2021 OPPS final rule, released December 2, doesn’t pack many surprises, with CMS generally finalizing most policies as proposed or choosing to continue with current policies. This should aid hospitals required to implement many of its policies in just a few short weeks due to the pandemic-disrupted rulemaking cycle.

Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. Use these tips to create a multidisciplinary strategy that gives you a clear view into processes.

Review 2021 ICD-10-CM codes for behavioral health diagnoses and a breakdown of CPT guidelines for psychiatric diagnostic evaluations.

Valerie A. Rinkle, MPA, CHRI, writes about Medicare guidance on and updated payment policies for COVID-19 testing, vaccines, and telehealth services.

Q: How does case-mix index (CMI) impact hospital finances? What should revenue integrity staff look for when conducting CMI analyses?

Valerie A. Rinkle, MPA, CHRI, reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.

Several recent changes affect hospitals’ 340B programs. Follow these eight tips to review and optimize your hospital’s 340B program.

Determining which denials could be overturned on appeal is key to a successful denial management program. Learn how to leverage your appeal team's knowledge to create a data-driven scoring system.