CMS removes two codes from prior authorization list

Wed, 05/19/2021
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, Coverage, News, Revenue Integrity

Two CPT® codes are temporarily suspended from the prior authorization program for hospital outpatient departments, CMS announced.

CMS updates telehealth list, cautions organization to pay attention to billing rules

Wed, 04/21/2021
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Coverage, News, Revenue Integrity

CMS released an updated list of Medicare telehealth services while cautioning organizations to pay close attention to telehealth billing rules.

Tackling COVID-19 Vaccination Billing Challenges: A System Approach (April 8, 2021)

Submitted by jfitzgerald@hcp... on Thu, 04/08/2021 - 15:47

Topic: Tackling COVID-19 Vaccination Billing Challenges: A System Approach

Featuring:

  • Melissa Deuel, System Manager, Charge Master, CommonSpirit Health
  • Christian S. Gabriel, National Director of Revenue Integrity, CommonSpirit Health
  • Marie Garcia, System Manager, Revenue Integrity, CommonSpirit Health
  • Kay Larsen, CRCR, CHRI, Revenue Integrity Specialist, Adventist Health Glendale

 

Using CMS and NAHRI resources to address charge denials

Wed, 04/07/2021
Revenue Integrity Insider
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Denials and Appeals, Policies and Procedures, Revenue Integrity

Learn how to use NAHRI resources and CMS and HIPAA requirements to appeal inappropriate charge denials.

Sample Payer Charge Denial Letter

Wed, 04/07/2021 - 09:55
Policies & Procedures
Billing and Claims, Chargemaster and Charge Capture, Monitoring and Audits, Revenue Integrity

Use this sample payer charge denial letter to use as a template when drafting appeal letters.

Revenue integrity tips for 2021

Wed, 04/14/2021
Revenue Integrity Insider
Billing and Claims, Reimbursement and Payment Methodologies

Much like other areas of healthcare, the world of revenue integrity has undergone quite a bit of change over the past year. On the March 11 episode of The Revenue Integrity Show: a NAHRI Podcast covered a wide range of topics related to revenue integrity in the era of the novel coronavirus (COVID-19).

Download the April 2021 issue of the NAHRI Journal

Tue, 04/06/2021
NAHRI Journal - Volume 5, Issue 2
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Denials and Appeals, Monitoring and Audits, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

Explore the revenue integrity universe.

The influence of revenue integrity

Tue, 04/06/2021
NAHRI Journal - Volume 5, Issue 2
Billing and Claims, Compliance, Reimbursement and Payment Methodologies, Revenue Integrity

Ronald Hirsch, MD, FACP, CHCQM, CHRI, looks at recent regulatory changes that fall under revenue integrity’s influence.

NAHRI Professional Advocacy Committee guidance on vaccine administration

Wed, 03/31/2021
Revenue Integrity Insider
Billing and Claims, Reimbursement and Payment Methodologies

Some providers appear to be struggling with “how” and “whether or not” to bill for COVID-19 vaccine administrations. On March 15, 2021, CMS increased the per-injection reimbursement to $40. CMS has recognized that there is added cost to the administering provider because of the increased resources involved in mass immunizations required to control a pandemic. 

CMS increases COVID-19 vaccine payments

Wed, 03/24/2021
Revenue Integrity Insider
Billing and Claims, News, Reimbursement and Payment Methodologies, Revenue Integrity

CMS recently boosted Medicare payments for COVID-19 vaccines as part of an effort to accelerate vaccinations.

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