August 12, 2019
News & Insights

Q: What is the difference between a Medicare claim appeal (redeterminiation) versus reopening of a claim?

July 30, 2019
News & Insights

CMS released the 2020 OPPS proposed rule July 29, proposing to refine previous policies related to price transparency and the 2-midnight rule, while also asking for comments on how to potentially undo its policy that reduced payments for drugs purchased under the 340B drug discount program by nearly 30%.

July 26, 2019
News & Insights

Facilities need to know how to respond to documentation requests as part of any Medicare audit or review. Preparing a complete and proper reply makes all the difference in the outcome or results of those audits and reviews.

July 25, 2019
News & Insights

Past Revenue Integrity Symposium (RIS) attendees and speakers agree: It’s a can’t-miss event for revenue integrity education and networking. The best part? Savvy revenue integrity professionals can take advantage of several ways to save on the cost of attendance, scoring premier education without breaking the budget.

July 1, 2019
Briefings on APCs

In 2013, “Guidelines for Achieving a Compliant Query Practice,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. The 2019 update reinforces the information set forth in the preceding practice briefs while also introducing some newer guidelines reflective of today’s healthcare environment.

July 8, 2019
News & Insights

Q: What are Medicare's criteria for reopening a claim as opposed to treating it as a denial?

June 1, 2019
Briefings on APCs

The NCCI manual can be a powerful tool for revenue cycle staff to understand the intricacies of CMS modifier rules and Medicare edits.

June 10, 2019
News & Insights

Q: What is the difference between a hard and a soft denial?

June 1, 2019
Briefings on APCs

Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.

May 20, 2019
News & Insights

CMS finalized a rule on May 7 aimed at streamlining the Medicare appeals process by removing the signature requirement for appeal requests of Parts A and B claims and Part D prescription drug coverage determinations.

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