Organizations continue to struggle with denials for conditions such as sepsis and pneumonia. Review your processes and then apply these expert tips to help turn the tide.
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
The HIM department plays a critical role in the revenue cycle, but it’s often placed in a reactive position, limiting its effectiveness. Learn how to improve operations by enhancing the HIM department’s involvement across the revenue cycle.
Revenue integrity experts shared advice and lessons learned over the past months during day one of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event.
Drafting an effective appeal in response to payer audits and overpayment demands goes beyond just coding and billing; it also often requires a deeper analysis and technical response. Discover methods to improve your appeals strategy with an eye on facts and compliance.
Determining which denials could be overturned on appeal is key to a successful denial management program. Learn how to leverage your appeal team's knowledge to create a data-driven scoring system.
Q: As utilization review case managers, we are often tasked with assessing our hospital's risk for novel coronavirus (COVID-19) denials. What are the most important measures we should be examining?
Judith L. Kares, JD, writes about the unique coverage, billing, and payment rules that apply to these blood products and related services under Part B.
