Billing and Claims

CMS is weighing an expansion of the hospital outpatient department prior authorization program, changes to 340B reimbursement in the wake of the Supreme Court’s decision, and alternative rate setting data among other proposals in the 2023 Outpatient Prospective Payment System (OPPS) proposed rule.

A recording of the NAHRI Leadership Council’s July 13 meeting is now available.

In the 2022 NAHRI Leadership Council survey: Custom Edits—Creation and Workflow, 100 leaders, including revenue integrity, health information management (HIM), and coding directors and managers primarily from acute care hospitals and health systems with 500+ beds shared key insights into their custom edit processes, including workflow locations, oversight hierarchy, and the leading factors that drive custom edits.

Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-19-related billing flexibilities, and value-based care, according to the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule released July 7.

Focus on the people and processes that make revenue integrity work.

Consider how CMS’ proposed changes could affect reimbursement and revenue integrity operations.

Understand how to navigate evolving guidance on observation services and medical necessity.

Brush up on revenue integrity essentials for critical access hospitals and rural health clinics.