Revenue Integrity

NAHRI Advisory Board member Caroline Znaniec, MBA, MS-HCA, shares how hospitals can identify and improve compliance with price transparency rules.

CMS recently boosted Medicare payments for COVID-19 vaccines as part of an effort to accelerate vaccinations.

Preparing to comply with CMS’ Hospital Price Transparency final rule was no mean feat for revenue integrity professionals, and an already significant lift was made heavier by the COVID-19 pandemic. Learn how one organization used teamwork to adapt to changes in plan and meet their goals.

Q: Our system has a new vendor that is helping with charge capture. We were discussing surgery level charges and a comment was made about rounding that surprised me: We don't have to follow rounding rules to select the additional 15 minutes after the first hour. The vendor acknowledged that Medicare does have rounding rules, but because the rounding rules are not listed in or specifically tied to any surgery documentation, then the rounding rules don't apply to surgery. If the total surgery time was 61 minutes, then we would have one first hour charge and one additional 15-minute charge. The vendor assured us that this was a common practice throughout all hospitals. Is this true?

On the latest episode of The Revenue Integrity Show: A NAHRI Podcast, listeners were treated to in-depth discussions on two of the hottest topics in the industry — updates to the inpatient-only list and price transparency.

Six codes for telehealth services are newly eligible to reported with modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the public health emergency.