Billing and Claims

UnitedHealthcare’s (UHC) plan to require in-network, freestanding and outpatient laboratory claims to contain a unique code for most lab testing services is poorly timed and poses significant implementation hurdles, the American Hospital Association (AHA) said in an August 14 letter.

Q: Is there a national standard for what documentation must be submitted to Medicare Administrative Contractors (MAC) when requesting prior authorization?

Inpatient novel coronavirus (COVID-19) claims will require a positive viral test result to be eligible for the 20% increase in the MS-DRG weighting factor, effective for admissions on or after September 1.

High-level continued learning and engaged networking with peers are critical to revenue integrity professionals as healthcare regulations transform each year. We are excited to announce we will host Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event from October 6‒8, 2020, to ensure revenue integrity professionals have access to the focused education and innovative networking they have come to expect from NAHRI.

CMS’ latest round of updates to its novel coronavirus FAQs on Medicare fee-for-service billing provides additional information on hospital billing for remote services, including a decision tree guiding hospitals through their options for billing for telemedicine.

An appeals court ruled that CMS has the authority to implement a controversial site-neutral payment policy. The ruling, delivered July 17, reversed a 2019 district court decision that vacated the policy.

The Duke University Health System in Durham, North Carolina, has more than 1,200 inpatient beds, handles two million outpatient visits annually, and serves as one of the country’s leading research institutions. As the director of revenue and documentation integrity at Duke Health, Garland Goins, MBA is tasked with structuring its complex revenue integrity department.