Revenue Integrity

CMS will begin reprocessing 2019 claims for some services rendered at excepted off-campus provider-based departments. The affected claims are for services represented by HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient) with dates of service between January 1, 2019, and December 31, 2019.

CMS is expanding payments for at-home COVID-19 vaccinations to include communal spaces in multi-unit living settings or communal arrangements.

Q: How should we bill for trauma activation without pre-hospital notification and how should we capture charges for these services? Do we bundle the charge in with the facility evaluation and management (E/M) code?

Finding and addressing the roor causes of coding edits is essential to revenue integrity, but when the issue points back to clinical departments it can often be a challenge to get them on board with change. Use these tips to gain clinical departments' support and implement practical, colloboartive solutions.