Billing and Claims

Revenue integrity leaders looking to make an impact on the professional fee side of their organizations need to understand the unique opportunities

CMS is considering a significant change to how it pays for certain high-cost radiopharmaceuticals, as well as a sweeping new set of Conditions of Participation (CoPs) aimed at maternal health, and a slew of other changes in the 2025 Outpatient Prospective Payment System (OPPS) proposed rule.

Organizations could see a flood of new codes along with significant changes to the Medicare Shared Savings Program (MSSP) and coverage of telehealth services, according the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule.

CMS recently updated an MLN Fact Sheet on Medicare Part D vaccines to clarify billing and formulary policies.

Consider how CMS’ proposed changes for 2025 could affect hospitals.

Review changes to skin substitute billing and coding in the July 2024 ambulatory surgical center payment system update.

Part A providers and Part B suppliers have until July 12 to apply for Change Healthcare/Optum Payment Disruption (CHOPD) accelerated and advance payments.

During 2024 Revenue Integrity Week, NAHRI is focused on raising awareness of the value that revenue integrity professionals bring to their organizations. By shining a light on best practices, data, and forward-thinking strategies, we can help revenue integrity professionals demonstrate everything they contribute to the healthcare industry.