MSSP overhaul

Wed, 10/02/2024
NAHRI Journal - Volume 8, Issue 4
Compliance, Reimbursement and Payment Methodologies, Revenue Integrity

Catch up on potential changes to the Medicare Shared Savings Program (MSSP).

Staying up to date with NCCI edits

Wed, 10/02/2024
NAHRI Journal - Volume 8, Issue 4
Billing and Claims, Coding and Documentation, Compliance, Monitoring and Audits, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Review recent changes and compliance tips for NCCI edits.

DSH payments: Understanding compliance, payment, and opportunities

Wed, 10/02/2024
NAHRI Journal - Volume 8, Issue 4
Compliance, Reimbursement and Payment Methodologies, Revenue Integrity

Dig deeper into compliance and reimbursement issues for disproportionate share hospitals.

CMS issues revenue code fix for cardiac CT services

Wed, 10/02/2024
Revenue Integrity Insider
Billing and Claims, News, Reimbursement and Payment Methodologies, Revenue Integrity

After receiving responses to a recent request for information, CMS issued a revenue code fix for cardiac CT services.

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

Pages