Medicare Advantage Organizations (MAO) sometimes inappropriately delay or deny beneficiaries’ access to medically necessary care, according to a recent OIG report. The OIG conducted a study and found that Medicare Advantage beneficiaries were denied access to services such as advanced imaging services and postacute facility stays.
Revenue Integrity Week, to be held June 6–10, is fast approaching. This annual week of recognition for revenue integrity professionals is the perfect opportunity to lift up your colleagues and raise awareness of the invaluable work they do to support their organizations.
The new guidance covers how payment determinations are made, what information may and may not be used, and the scope of independent dispute resolution entities’ decisions.
Among the proposed changes, many of which affect quality and data reporting programs, are proposed changes to claims data used for rate setting, a delay of the three way split criteria for MS-DRGs, and more.
The agenda for the 2022 Revenue Integrity Symposium (RIS) has been released. The event, to be held September 19–20 at the Hilton Phoenix Resort at the Peak in Phoenix, Arizona, will feature two educational tracks covering essential revenue integrity education, updates, and thought leadership.
