Billing and reimbursement

Q: How can we help our physicians improve their documentation of medical necessity?

 Millions of medical records are sent to insurance companies every year by hospital and health system business office personnel to expedite claims payment, respond to payer audits, or fulfill other payer denial requests for information. And any time medical records are handled, HIPAA concerns come into play.

CMS recently released updated guidance on billing intensity-modulated radiation therapy (IMRT) after an OIG audit found a 100% error rate in billing certain IMRT planning services.

Follow in the footsteps of leading organizations and get the most out of your denial programs with these four steps.

Q: How can coding and patient financial services staff work together to create an effective claims edit team?

To effectively report opioid use, abuse, and dependence, coding and billing professionals must be able to recognize symptoms of these disorders and interpret detailed ICD-10-CM guidelines. Additionally, they must be able to identify complications associated with opioid misuse and overdose.

Q: Are there reimbursement codes for transition services that case managers provide?

Modifiers -25 and -27 are used in the outpatient facility setting on E/M services. Learn more about how these modifiers should be applied in accordance with coding and Medicare guidelines.

NAHRI is hosting the 2018 Revenue Integrity Symposium (RIS) October 16–17 at the Wigwam Resort in Litchfield Park (Phoenix), Arizona. The conference is an important event for revenue integrity networking and education.

Q: What is a denial avoidance program and how does it differ from a denials management program?