Revenue Integrity

When hospitals or provider entities merge under one system structure, particularly when moving onto a new EMR or practice management system platform, it can be a heavy lift for all parties involved as they work to ensure a successful transition and structure a strong foundation for future growth.

A study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.

Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting edits to change it to 771. What are your thoughts and suggestions?

Most off-campus provider-based departments (PBD) that claimed the mid-build exception under the 21^st Century Cures Act failed to meet the requirements and have likely received overpayments, according to CMS.

NAHRI’s January 26 Quarterly Call featured important association updates, as well as presentations on the new price transparency requirements and the 2021 OPPS final rule.

NAHRI is currently accepting applications for its advisory board. Taking an active role in NAHRI can set you on the path to shape the future of the revenue integrity profession as well as advance your career. 

CMS recently released FAQs clarifying how it will collect data on market-based MS-DRG relative weights and changes to its methodology for calculating MS-DRG relative weights.