As the revenue integrity profession evolves, there will be a greater need to streamline its roles and responsibilities. While some revenue integrity professionals have been in the game for years and have established departments or programs, others find themselves in new roles without much direction from facility leadership as to what their focus should be. In the spirit of Revenue Integrity Week, which celebrates the diligence and dedication of revenue integrity professionals, NAHRI took a deep dive into the activities, backgrounds, and challenges of revenue integrity professionals.
Q: We recently had a consultant recommend that we create evaluation and management (E/M) levels for our labor and delivery observation cases, similar to our emergency room levels. Does anyone do this? If so, would you be willing to share your criteria and logic used?
The improper payment rate for routine venipuncture lab tests was 16.3% in 2018, representing more than $20 million, and medical necessity errors accounted 98.9% of the improper payments, according to CMS.
CMS recently reissued Special Edition MLN Matters 19002 to address lingering provider questions surrounding the application of the 2-midnight rule to total knee arthroplasty (TKA) claims. The MLN Matters article was originally released January 8 but was reissued January 24 to correct errors.
