It’s no secret that one of the most challenging aspects in revenue cycle management is keeping track of the numerous complexities associated with managed care contracts. Getting it right (or missing the opportunity) can greatly impact revenue integrity initiatives and financial performance—both...Read More »
More hospitals are cash strapped than any time since the 2008 financial crisis, according to a 2017 Moody’s Investors Service survey. Not-for-profit and public hospitals, in particular, are feeling the squeeze with median operating cash-flow margins at a 10-year low. High labor costs and lower...Read More »
In the spirit of Revenue Integrity Week, which is designed to celebrate the diligence and dedication of revenue integrity professionals, NAHRI’s State of the Revenue Integrity Industry Survey once again took a deep dive into the roles of revenue integrity professionals, the activities they are...Read More »
CMS modified its proposal to expand prior authorization and step therapy to protected classes of drugs for Part D and Medicare Advantage beneficiaries, according to a final rule released May 16.Read More »
The Revenue Integrity Symposium is the only conference I have seen that is packed with sessions that will give revenue integrity professionals practical information that they can take back and institute the next day to help their facility success financially. Read More »
Commercial and government payers track chronic conditions using Hierarchical Condition Category (HCC), and providers can track HCCs to better monitor and project reimbursement and compliance.Read More »
U.S. District Judge Rudolph Contreras last week reaffirmed that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it made 2018 payment cuts to outpatient hospitals for certain drugs purchased through the 340B drug pricing program, and extended the ruling to 2019...Read More »
Q: I was on a conference call with the CDM coordinators within my health system and we got involved in a lively discussion. If there's no medical necessity for observation, what do you do with charges? Our departments get productivity based on the charges posted. We all agreed that the...Read More »
