On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the federal fiscal year (FFY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule. Our government reimbursement experts did the heavy lifting for you and...
Following is the text of NAHRI's comments to CMS on the proposed changes to the Medicare Outpatient Prospective Payment System and proposed calendar year 2025 rates. Download them below. You may use this letter as a template for submitting your own comments to CMS on any of the topics addressed...
Denials management is critical for providers facing rising denial rates, especially in medical necessity claims, which can delay cash flow and increase appeal costs.
To maintain financial stability and operational efficiency, healthcare organizations must enhance clinical...
Denial prevention continues to be a top priority in today’s healthcare revenue cycle. From optimizing claim submission to activating an appeals plan, you’ll get every action item you need to prevent and overturn denials — plus key metrics to track as you go.
Learn how to adopt an end-to-end platform strategy and help avoid managing multiple vendors, migrate operational and security vulnerabilities associated with maintaining disparate systems, and concentrate on patient care.
Denials are a constant thorn for healthcare organizations, and are often caused by factors outside of an organization’s control, such as to new payer rules or patients switching medical plans. When left unchecked, claim denials can represent an average loss of up to 5% of net patient revenue.
Accurate revenue code selection affects concerns central to revenue integrity and the operations of healthcare provider organizations such as compliance and reimbursement. In this white paper, NAHRI Advisory Board Valerie Rinkle, MPA, CHRI, explains the importance of accurate revenue code...
In this position paper, the NAHRI Advisory Board breaks down the steps involved in writing and submitting comments on proposed rules and policy changes and discusses why this activity is essential for revenue integrity professionals.
The 2022 NAHRI Leadership Council Survey Part 2 examines claim edit patterns, pre-billing processes, and top payer trends.
In addition to clinical areas, the last two years of the COVID-19 pandemic also introduced massive disruption to the revenue cycle, skewing billing processes and...
