Billing and Claims

Q: Is it true that billing anesthetic drugs with injection procedures in outpatient clinic encounters is unbundling packaged services?

Q: Is there any specific guidance on what nursing services should be included in room and board and covered under routine services?

Clinical research studies can offer enormous benefits for patients and provider organizations. But managing charges and submitting claims for clinical research can throw a curveball at revenue integrity teams. Without efficient charge and edit management processes, revenue integrity could find itself striking out.

More than 100 NAHRI members tuned in to hear expert advice on revenue integrity hot topics and get the scoop about exciting new NAHRI initiatives during our second members-only quarterly call on April 24.

Q: Can you charge a cancelled surgery if the patient is not taken to the procedure room?

There are two parts of maintaining correct audits: ensuring that the charges present on the claim accurately represent the care provided and documented and ensuring the claim is compliant with all applicable billing rules and regulations. One way to ease the process is to review the charges on the claim with an application or tool that can predict errors using the analytics from outpatient Medicare claim data.