Policies & Procedures

Denial prevention committee charter

Thu, 06/06/2024 - 11:46

This sample policy was provided to the National Association of Healthcare Revenue Integrity (NAHRI) by Erin Brearley Cutter, MBA, CHRI, CRCR, COC, CPC, revenue integrity director at Concord Hospital Health System in New Hampshire.

Denial prevention policy

Wed, 06/05/2024 - 11:57

Policies & Procedures

Denials and Appeals, Policies and Procedures

Outpatient CDI: Staff evaluation form

Mon, 05/06/2024 - 11:46

Policies & Procedures

Coding and Documentation, Program Management, Revenue Integrity

Thanks to Valerie Parent, RN, BSN, CCDS, CCRN-K, for donating the attached outpatient CDI staff evaluation form. Parent is the clinical documentation improvement manager at Eastern Maine Medical Center in Bangor, Maine.

This sample was provided by NAHRI's sister association, the...

Sample utilization review guideline language for payer contracts

Wed, 07/12/2023 - 10:26

Policies & Procedures

Payer Contracting, Revenue Integrity

Use this sample language as a guide when developing or reviewing payer contracts.

Significant Medicare PHE extensions and adjustments: Physician services

Wed, 04/12/2023 - 09:31

Policies & Procedures

Billing and Claims, Coding and Documentation, Compliance, Coverage, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Use these charts to identify extensions and end dates for COVID-19 public health emergency (PHE) waivers and flexibilities and effected services for physician services.

Significant Medicare PHE extensions and adjustments: Rural health clinics and Federally Qualified Health Centers

Wed, 04/12/2023 - 09:30

Policies & Procedures

Billing and Claims, Coding and Documentation, Compliance, Coverage, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Use these charts to identify extensions and end dates for COVID-19 public health emergency (PHE) waivers and flexibilities and effected services in rural health clinics and Federally Qualified Health Centers.

Significant Medicare PHE extensions and adjustments: Hospitals and critical access hospitals

Wed, 04/12/2023 - 09:25

Policies & Procedures

Billing and Claims, Coding and Documentation, Compliance, Coverage, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Use this chart to identify extensions and end dates for COVID-19 public health emergency (PHE) waivers and flexibilities and effected services in hospitals and critical access hospitals.