Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality.
Denials management has gained new urgency as payers adopt more aggressive tactics and hospitals continue to face revenue shortfalls. Learn how organizations are structuring denials management and reporting denials and appeals data.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
Tracking denials data as a key performance indicator (KPI) can help identify gaps in provider documentation and create meaningful physician education. Learn how to leverage coding and CDI staff in tracking and managing denials data.
As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) toInterQual.
Interventions to reduce length of stay for high-risk, medically complex, and otherwise vulnerable patients are falling short, according to a technical brief prepared for the Agency for Healthcare Research and Quality.
Objective information produced by electronic data is fast becoming an essential component of value-based care and permeates every component of the healthcare ecosystem. Learn how to use electronic remittances as a source of truth for denials.
CMS has reinstated the short-stay reviews and high-weighted DRG reviews originally halted in 2019. The national contract to conduct these reviews was awarded to Livanta, one of the Beneficiary & Family-Centered Care and Quality Improvement Organizations.
