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.

Successfully responding to payer charge audits for services billed above room and bed rate can be a challenge. The Cleveland Clinic contracting, compliance, and revenue cycle departments worked together on a project to address this focus.