Revenue Integrity

Q: Are outpatient departments considered part of the therapy cap for hospital-owned facilities? If so, do we need to bill with modifier –KX (Type of Bill 012X)? I want to ensure I’m billing correctly.

Managing charge capture in a multi-hospital system that spans a variety of service lines and charges can prove to be a daunting task both in terms of ensuring claims are accurate and ensuring team members are well versed in each service line and charge type. While some health systems may train staff across all areas of charge capture, Saint Luke’s Health System in Kansas City, Missouri, opted to assign each team member a role in which they could become experts.

Q: Can a hospital bill for orthotic or prosthetic supplies (e.g., leg brace for a patient in the ED or clinic) on the hospital claim? What are the requirements for billing these supplies? Is revenue code 0274 the correct revenue code? Are HCPCS codes needed?

To close an open encounter, the following ingredients are required: one completed progress note, one chief complaint, a diagnosis, and a physician level of service. Combine all four in EPIC and you're ready to post charges.

NAHRI kicked off the new year by hosting its first quarterly members-only call, which featured insights from board members on hot topics revenue integrity professionals should keep on their radar this year.

The National Association of Healthcare Revenue Integrity is currently seeking speakers to present at the 2018 Revenue Integrity Symposium, to be held October 16–17, 2018, at the Wigwam Resort just outside of Phoenix in Litchfield Park, Arizona. Is that special person you or a colleague?

If you or your peers are interested in becoming NAHRI charter members, our member justification letter can help you get the buy-in you need to from program administrators at your facility.