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Q&A: Code removal requests from payers

Wed, 12/31/2025
Revenue Integrity Insider
Ask NAHRI, Payer Contracting, Denials and Appeals, Coding and Documentation

Q: How do you handle clinical validation denials when payers say you won’t receive payment unless you remove a code from the claim? 

Catching up with NAHRI

Wed, 12/24/2025
Revenue Integrity Insider
Revenue Integrity, News

Check out these recommended opportunities and make the most of the last few weeks of the year.

Q&A: GenAI in revenue integrity

Wed, 12/24/2025
Revenue Integrity Insider
Ask NAHRI, Revenue Integrity, Program Management

Q: How are revenue integrity departments using generative artificial intelligence (GenAI) to carry out specific functions?

Improving interdepartmental communication to combat denials

Fri, 12/19/2025
Leadership Council Insider
Revenue Integrity, Program Management, NAHRI Leadership Council, Denials and Appeals, Coding and Documentation

While communication is key to reducing denials, it’s very difficult to do well, according to Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS,

CMS relaunches PEPPER for short-term acute care hospitals

Wed, 12/17/2025
Revenue Integrity Insider
Billing and Claims, News, Monitoring and Audits, Compliance

CMS recently relaunched the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals, restoring these facilities’ access to a valuable data tool that assists with claim accuracy.

OPPS Drug Acquisition Cost Survey to begin January 1

Wed, 12/10/2025
Revenue Integrity Insider
Revenue Integrity, News, Monitoring and Audits, Compliance

CMS is preparing to launch the Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey to collect acquisition costs for certain outpatient drugs and biologicals.

New edit targets improper payments for hospice services

Wed, 12/03/2025
Revenue Integrity Insider
Revenue Integrity, Billing and Claims, News, Coding and Documentation

CMS recently created a new system edit to help reduce improper Medicare payments for outpatient services provided by acute care hospitals to hospice patients.

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NAHRI Forums

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NAHRI Forum
Wed, 07/12/2017 - 13:31
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