Case study: Implementing annual CPT code updates

Wed, 07/12/2023
NAHRI Journal - Volume 7, Issue 3
Chargemaster and Charge Capture, Coding and Documentation, Policies and Procedures, Program Management, Revenue Integrity

Learn how one organization successfully manages cross-functional processes for annual CPT updates.

Sample utilization review guideline language for payer contracts

Wed, 07/12/2023
NAHRI Journal - Volume 7, Issue 3
Payer Contracting, Policies and Procedures, Revenue Integrity

Use this sample language as a guide when developing or reviewing payer contracts.

CMS releases list of Part B drugs with reduced coinsurance

Wed, 06/21/2023
Revenue Integrity Insider
Coverage, News, Policies and Procedures, Revenue Integrity

CMS recently released a list of the 43 Part B drugs and biologicals that will be included in the Medicare Prescription Drug Inflation Rebate Program for July 1–September 30.

Q&A: Implementing processes for denials management

Fri, 06/09/2023
Revenue Integrity Insider
Denials and Appeals, Policies and Procedures, Revenue Integrity

Q: What processes or systems do you have in place for managing denials?

Q&A: Assigning responsibility for charge entry

Thu, 06/08/2023
Revenue Integrity Insider
Chargemaster and Charge Capture, Policies and Procedures, Program Management, Revenue Integrity

Q: If a clinical department does not enter their own charges, what staff member holds that responsibility?

Q&A: Collaborating with other departments on chargemaster approvals

Wed, 06/07/2023
Revenue Integrity Insider
Chargemaster and Charge Capture, Policies and Procedures, Program Management, Revenue Integrity

Q: How do you work with other departments when approving requests for changes to the chargemaster?

2023 State of the Revenue Integrity Industry Survey Report

June 2, 2023
Industry Report
Billing and Claims, Chargemaster and Charge Capture, Compliance, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

NAHRI is celebrating the sixth annual Revenue Integrity Week (June 5–9) to acknowledge and raise awareness of the invaluable contributions of revenue integrity professionals in the healthcare industry. With the 2023 State of the Revenue Integrity Industry Survey Report, NAHRI is taking an in-...

Comply With CAH Telehealth Reporting Guidelines

Fri, 06/02/2023 - 16:42
Webinars
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

Sandy Giangreco Brown, MHA, BS, RHIT, CCS, CCS-P, CHC, COC, CPC, CPC-I, COBGC, PCS, and Jennifer Campbell, CMPE, CPC, CPB, discuss how rural health clinic (RHC) and critical access hospital (CAH) may charge for telehealth services, what documentation is necessary, and more.

Prior Authorization for Hospital Services: Utilization Control or Compliance Initiative?

Fri, 06/02/2023 - 16:38
Webinars
Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Policies and Procedures, Program Management, Revenue Integrity

Kimberly A. Hoy, JD, CPC, covers the ins and outs of the prior authorization program for hospital outpatient services.

Medicare Advantage and the 2-Midnight Rule: Level the Field With Medicare Advantage Payers

Fri, 06/02/2023 - 16:35
Webinars
Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Revenue Integrity

Jerilyn Morrissey, MD, clears up confusion about the regulations and explain how to determine when the 2-midnight rule applies to Medicare Advantage payers.

Pages