Billing and reimbursement

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.

Q: How can organizations develop a business case or plan for revenue integrity departments?

When evaluating a code edit, it’s necessary to understand exactly when or where in the claim or billing process the edit arose. Look to coding guidance to help edit resolution efforts.

CMS announced revised pricing for covered drugs and biologicals in the July 2018 update to the OPPS. Hospitals should thoroughly review all of the updates to ensure any required changes are in place by the stated effective dates.