2018 OPPS final rule: CMS to cut 340B drug program payments by 22.5%, hospitals plan litigation

Thu, 11/02/2017
Coding and Documentation, News, Policies and Procedures, Revenue Integrity

Despite opposition from many stakeholders, a bipartisan contingent of Congress, and CMS’ own advisory panel,the agency is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released November 1. 

A micro and macro look into MACRA

Mon, 10/02/2017
NAHRI Journal - Volume 1, Issue 4
Policies and Procedures, Revenue Integrity

Understand the rules and regulations of the Medicare Access and CHIP Reauthorization Act.

Takeaways from the Provider Roundtable

Mon, 10/02/2017
NAHRI Journal - Volume 1, Issue 4
Policies and Procedures, Revenue Integrity

Key issues discussed during the Provider Roundtable.

Components of revenue integrity

Thu, 09/28/2017 - 12:15
Policies & Procedures
Policies and Procedures, Program Management, Revenue Integrity

Use this resource as a guide on the processes that come together to form the revenue integrity cycle.

FDA approves $475,000 CAR-T therapy

Wed, 09/06/2017
Revenue Integrity Insider
News, Policies and Procedures

The Food and Drug Administration (FDA) approved the first gene therapy released in the U.S., Kymriah, also known as chimeric antigen receptor T-cell (CAR-T) therapy.

Condition code 44 letter to patient

Fri, 08/04/2017 - 09:51
Policies & Procedures
Policies and Procedures

Use this sample form as a guide for notifying patients of guidelines for Medicare outpatient/observation.

Post-discharge self-denial letter to doctor

Fri, 07/28/2017 - 09:06
Policies & Procedures
Denials and Appeals, Policies and Procedures

Use this sample letter to notify patients of a post-discharge self-denial by the utilization review committee.

KPIs for denials management and revenue integrity

Fri, 07/28/2017 - 09:02
Policies & Procedures
Denials and Appeals, Policies and Procedures, Revenue Integrity

This document provides guidance on key performance indicators for denials management and revenue integrity, including calculations for denials rates and denials overturn ratios.

Utilization management committee agenda

Fri, 07/28/2017 - 08:55
Policies & Procedures
Policies and Procedures, Program Management

This sample form helps identify utilization management committee tasks and responsibilities.

Presentation: The power of the utilization management committee

Fri, 07/28/2017 - 08:50
Policies & Procedures
Policies and Procedures, Program Management

This presentation provides gudiance on utilization management committee structure and accountability.

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