by Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP
Managing claim denials is essential for healthcare organizations to maintain financial health and operational efficiency. Rising denial rates, particularly for medical necessity claims, are leading to...Read More »
After publishing the 2025 Medicare Physician Fee Schedule (MPFS) final rule, CMS provided more information on upcoming changes to the Medicare Shared Savings Program (MSSP). Read More »
Organizations must prepare for a slew of new codes and billing updates for Part B payment, according to the 2025 Medicare Physician Fee Schedule (MPFS) final rule. The final rule, released November 1, details CMS’ numerous changes to payment rates, billable services, telehealth rules, and other...Read More »
CMS gave the green light to improved payments for high-cost radiopharmaceuticals and made changes to its payment calculation for cardiac CT services among other updates in the 2025 Outpatient Prospective Payment System (OPPS) final rule.Read More »
CMS issued a final rule to establish several new appeals processes for Medicare beneficiaries who want to challenge a hospital’s decision to reclassify their status.Read More »
CMS added new Healthcare Common Procedure Coding System (HCPCS) codes and made status indicator (SI) and code descriptor changes for outpatient skin substitute claims.Read More »
Collaborating with other departments can help paint a better picture of the organization’s current charge reconciliation structure and practices, which can illuminate what revenue integrity’s role is. “We’ve been able to make some headway on overcoming our hurdles by working closely with our...Read More »
