Policies and Procedures

How to tune up your revenue integrity program

Wed, 04/10/2024

Policies and Procedures, Program Management, Revenue Integrity

Apply these best practices to ensure your program’s staffing and metrics make sense.

Don’t forget to validate orders

Wed, 04/10/2024

Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Policies and Procedures, Revenue Integrity

Understand how to improve documentation and prevent denials due to missing or invalid orders.

NAHRI Leadership Council Meeting (03-27-24)

Thu, 03/28/2024 - 09:50

Council Resources

Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, NAHRI Leadership Council, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Internal off-site defense audits requested by external parties protocol

Tue, 03/26/2024 - 11:59

Council Resources

Monitoring and Audits, NAHRI Leadership Council, Policies and Procedures, Revenue Integrity

This sample protocol for internal off-site defense audits requested by external parties was submitted by 2024 NAHRI Leadership Council member Christie G. Wallen, ARCR, supervisor, revenue integrity, charge integrity at Prisma Health in Greenville, South Carolina.

Late charge reporting policy

Tue, 03/26/2024 - 11:56

Council Resources

Chargemaster and Charge Capture, NAHRI Leadership Council, Policies and Procedures, Revenue Integrity

This sample policy for late charge reporting was submitted by 2024 NAHRI Leadership Council member Christie G. Wallen, ARCR, supervisor, revenue integrity, charge integrity at Prisma Health in Greenville, South Carolina.

Q&A: Understanding CMS’ proposed changes to appeal rights

Wed, 02/21/2024

Revenue Integrity Insider

Ask NAHRI, Compliance, Coverage, Denials and Appeals, News, Policies and Procedures, Revenue Integrity

CMS is proposing significant changes to certain appeal processes for Medicare beneficiaries. In this Q&A, Kimberly A. Hoy, JD, CPC, director of Medicare and compliance for HCPro LLC, in Chicago, explains how the rule could affect hospitals, including new required notices and potential billing process updates, and strategies for managing patient status changes.