CMS launches new model to test prior authorization improvements

Wed, 07/02/2025
Revenue Integrity Insider
Billing and Claims, Compliance, Coverage, News, Reimbursement and Payment Methodologies, Revenue Integrity

CMS recently announced it will partner with companies specializing in enhanced technologies to test improvements to prior authorization processes via a new Innovation Center model.

CMS publishes 2025 Q3 update for NCCI edit files

Wed, 06/18/2025
Revenue Integrity Insider
Billing and Claims, Chargemaster and Charge Capture, News

CMS posted the third quarter National Correct Coding Initiative (NCCI) edit files, which will take effect on July 1. 

How to keep up with changing rules and regulations

Wed, 06/11/2025
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, Coverage, Payer Contracting, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Learn how to stay current with and navigate changing reimbursement rules and regulations to protect revenue and avoid compliance pitfalls.

Breaking Down the 2026 IPPS Proposed Rule

Fri, 06/06/2025 - 17:55
Webinars
Billing and Claims, Coding and Documentation, Compliance, Coverage, Reimbursement and Payment Methodologies, Revenue Integrity

Kimberly A. Hoy, JD, CPC, analyzes major proposals of the 2026 Inpatient Prospective Payment System (IPPS) proposed rule. This webinar is an edited version of the full, 60-minute program.

Q&A: Claim edit focus areas

Fri, 06/06/2025
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Program Management, Revenue Integrity

Q: What are some of the things you’re currently focusing on for claim edits?

Reduce Physician E/M Denials with Compliant Modifier -25 Reporting

Tue, 06/03/2025 - 10:03
Webinars
Billing and Claims, Coding and Documentation, Compliance, Denials and Appeals, Revenue Integrity

Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I, discusses how to support compliant reporting of modifier -25 and reduce denials.

Recipe for Success: 2025 State of the Revenue Integrity Industry

Mon, 06/02/2025
Revenue Integrity Insider
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Denials and Appeals, Monitoring and Audits, Policies and Procedures, Program Management, Revenue Integrity

Revenue integrity professionals need to understand how new elements in the healthcare industry, from changing regulations to advances in technology

Q&A: Identifying opportunities for expansion

Mon, 06/02/2025
Revenue Integrity Insider
Billing and Claims, Denials and Appeals, Payer Contracting, Policies and Procedures, Program Management, Revenue Integrity

Q: What areas or functions would you like to see your revenue integrity program take a bigger role in?

Exploring the OIG Workplan

Mon, 06/02/2025 - 10:14
Webinars
Billing and Claims, Coding and Documentation, Compliance, Denials and Appeals, Monitoring and Audits, Reimbursement and Payment Methodologies, Revenue Integrity

Leigh Poland, RHIA, CCS, CDIP, CIC, explains how to use the Office of Inspector General's (OIG) Work Plan to identify internal audit opportunities, shore up reimbursement compliance, and protect revenue.

2025 State of the Revenue Integrity Industry Report

June 2, 2025
Industry Report
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

NAHRI is celebrating the eighth annual Revenue Integrity Week (June 2–6) to acknowledge and raise awareness of revenue integrity professionals’ incredible contributions in the healthcare industry. To further support the goals and mission of revenue integrity and advance the development of...

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