CMS could have saved its beneficiaries an additional $2.9 million in 2017 had it implemented a more expansive price substitution policy for Part B drugs, according to an Office of Inspector General (OIG) report.
Findings from a Comprehensive Error Rate Testing (CERT) study show that insufficient documentation caused most improper payments for chiropractic services billed to Medicare in 2018, according to the July 2019 Medicare Quarterly Compliance Newsletter.
Behavioral health is a highly specialized area of coding that many coders and billers are unfamiliar with. There are hundreds of ICD-10-CM codes for mental disorders with unique characters to specify symptoms and complications.
Facility evaluation and management (E/M) coding is based on the facility resources utilized to provide medical care. Because CMS has not created national E/M guidelines for emergency department (ED) services, providers must create their own criteria for each visit level. Review your organization’s ED E/M leveling policies to ensure compliance.
CMS’ inpatient-only rule seems simple enough on the surface—certain specified procedures, all noted in the OPPS inpatient-only list, must be performed on an inpatient basis regardless of the patient’s expected length of stay. But as with anything in healthcare, implementing this rule is hardly simple, and many organizations continue to misapply it and lose revenue as a result. Get expert answers to common inpatient-only compliance stumbling blocks.
The American Hospital Association and several other hospital groups released a joint statement criticizing CMS’ proposed price transparency policy outlined in the calendar year 2020 OPPS proposed rule that would require hospitals to publish negotiated rates with private payers.
While there are many conferences that touch upon aspects of revenue integrity, RIS is the only one entirely dedicated to the topic. Plus, it is a great way to meet other professionals in the field of revenue integrity who are facing similar challenges and have similar interests.
