Billing and Claims

Q: What are some recommended educational resource on billing rules related to transplant services?

Less than a year after CMS finalized the three-year phaseout of the inpatient-only (IPO) list to be completed by 2024, the agency is looking to reverse course, according to the 2022 OPPS proposed rule, released Monday, July 19.

CMS is proposing a 4% decrease to the Medicare conversion factor, permanent expansion of telehealth coverage for some mental health services, and new timelines for Appropriate Use Criteria (AUC) reporting, according to the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule.

Balance billing for emergency services and certain other services will be subject to new limitations, according to an interim final rule with comment period released July 1 by HHS.

Reach the next level of revenue integrity

Brush up on the most recent changes to Medicare’s prior authorization requirements and their operational impact.

Consider how revenue integrity and utilization review teams can work together to meet shared goals.

Gain a fresh perspective on methods to efficiently address patient status changes.

Consider these case studies to understand how to apply condition codes 44 and W2.

Learn how to use regular internal audits and monitoring to boost compliance in revenue integrity areas.