Auditing and monitoring

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.

Judith L. Kares, JD, writes about the unique coverage, billing, and payment rules that apply to these blood products and related services under Part B.

Q: Are commercial payers allowed to conduct a pre- and post-payment review of the same claim?

CMS is planning to restart most Medicare fee-for-service medical reviews by August 3 regardless of the status of the public health emergency.