CMS releases OPPS, NCCI updates

Wed, 09/25/2024
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, News, Reimbursement and Payment Methodologies, Revenue Integrity

Review recent updates to the Outpatient Prospective Payment System (OPPS) and National Correct Coding Initiative (NCCI) edit files.

Advocating for change in the 2025 OPPS proposed rule

Fri, 09/20/2024
Leadership Council Insider
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, NAHRI Leadership Council, News, Reimbursement and Payment Methodologies, Revenue Integrity

Sample job description: Manager physician revenue integrity

Fri, 09/20/2024 - 09:39
Council Resources
NAHRI Leadership Council, Reimbursement and Payment Methodologies, Revenue Integrity

This sample job description for a manager, physician revenue integrity was submitted by NAHRI Leadership Council member Denise Wieber, director of professional HIM coding and revenue integrity, at Catholic Health in Melville, New York.

NAHRI’s comments to CMS on the 2025 OPPS proposed rule

Wed, 09/11/2024
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, Coverage, News, Reimbursement and Payment Methodologies, Revenue Integrity

NAHRI submitted comments to CMS on several key aspects of the calendar year (CY) 2025 Outpatient Prospective Payment System (OPPS) proposed rule.

NAHRI comments to CMS on the calendar year 2025 Outpatient Prospective Payment System proposed rule

Fri, 09/06/2024 - 20:59
White Papers
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, Reimbursement and Payment Methodologies, Revenue Integrity

Following is the text of NAHRI's comments to CMS on the proposed changes to the Medicare Outpatient Prospective Payment System and proposed calendar year 2025 rates. Download them below. You may use this letter as a template for submitting your own comments to CMS on any of the topics addressed...

Medicare Advantage prior authorization requests, denials on the rise

Wed, 08/28/2024
Revenue Integrity Insider
Coverage, Denials and Appeals, Payer Contracting, Reimbursement and Payment Methodologies, Revenue Integrity

Healthcare organizations are submitting more prior authorization requests to Medicare Advantage (MA) plans than they once were, and more of their r

CMS finalizes TEAM model in FY 2025 IPPS final rule

Wed, 08/14/2024
Revenue Integrity Insider
Compliance, News, Reimbursement and Payment Methodologies, Revenue Integrity

Learn more about the Transforming Episode Accountability Model (TEAM), a new mandatory episode-based payment model set to begin in 2026.

CMS finalizes new payment model, major updates to coding and billing in 2025 IPPS final rule

Wed, 08/07/2024
Revenue Integrity Insider
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, News, Reimbursement and Payment Methodologies, Revenue Integrity

Hospitals will need to prepare for a new mandatory bundled payment model and significant changes to coding and billing for certain new technologies, social determinants of health (SDOH), and more, according to the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) final rule.

NAHRI Quarterly Call - July 23, 2024

Wed, 07/24/2024 - 13:41
Quarterly Calls
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, News, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Listening to a NAHRI Quarterly Call (free for NAHRI members) qualifies for one CHRI CEU credit upon the completion of the accompanying survey. If you’re a NAHRI member and are interested in presenting on an upcoming NAHRI members-only call, please contact NAHRI at...

How to develop a professional fee revenue integrity program

Fri, 07/19/2024
Leadership Council Insider
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Denials and Appeals, NAHRI Leadership Council, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

Revenue integrity leaders looking to make an impact on the professional fee side of their organizations need to understand the unique opportunities

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