Billing and reimbursement

CMS began rolling out new cards to Medicare beneficiaries in April and recently announced that wave one of the mailing has been completed. The new cards are intended to help protect beneficiaries’ Social Security Numbers.

CMS could grant providers in certain Medicare Advantage plans another pathway to participate in an Advanced APM and be exempt from MIPS requirements.

Our facility is looking into outsourcing our transcription. What should we consider before we make the leap?

What is a good strategy for sharing denials data with the medical staff to ensure they understand weaknesses?

In the April 2018 OPPS update transmittal, CMS announced new HCPCS code C9749 (repair of nasal vestibular lateral wall stenosis with implant[s]), effective April 1, 2018.

The Office of Inspector General (OIG) plans to address concerns regarding capitated payment models by putting preauthorization denials under review.

How can revenue integrity professionals ensure drug units are properly represented in the charge description master?

A common error and audit finding affecting providers is the lack of a physician order or physician signatures on medical documentation.

What are the distinctions between hard and soft coding?

Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.