Hospital disputes OIG audit findings that estimate more than $22 million in overpayments for IRF and DRG errors

Wed, 03/06/2019
Revenue Integrity Insider
Billing and Claims, News, Revenue Integrity

Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect...Read More »

CMS proposes coverage with evidence development for CAR-T

Wed, 02/27/2019
Revenue Integrity Insider
Billing and Claims, Coverage, Reimbursement and Payment Methodologies, Revenue Integrity

CMS is seeking comments on a proposed coverage with evidence development for chimeric antigen receptor T-cell (CAR-T) therapy for relapsed or...Read More »

CMS: Medical necessity errors account for more than 90% of improper payments for routine venipuncture labs

Wed, 02/20/2019
Revenue Integrity Insider
Billing and Claims, Denials and Appeals, News, Revenue Integrity

The improper payment rate for routine venipuncture lab tests was 16.3% in 2018, representing more than $20 million, and medical necessity errors...Read More »

Use benchmarks to stop revenue leakage through small-dollar edits and denials

Wed, 02/13/2019
Revenue Integrity Insider
Billing and Claims, Denials and Appeals, Monitoring and Audits, Revenue Integrity

Learn how to track and evaluate small-dollar denials before they add up to major revenue losses.Read More »

Revenue integrity associate for edit management job description

Fri, 02/08/2019 - 15:00
Job Descriptions
Billing and Claims, Program Management, Revenue Integrity

Use this sample revenue integrity associate for edit management job description as a template for your facility.

Note from the director: 2019 Revenue Integrity Symposium keynote, location, dates announced

Wed, 01/30/2019
Revenue Integrity Insider
Billing and Claims, Chargemaster and Charge Capture, Denials and Appeals, Revenue Integrity

It’s hard to believe planning for the 2019 Revenue Integrity Symposium (RIS) is already underway. It feels like just yesterday we were all...Read More »

Q&A: Billing for test results after the patient leaves

Wed, 01/23/2019
Revenue Integrity Insider
Ask NAHRI, Billing and Claims, Revenue Integrity

Q: We have patients that come to the emergency department (ED), are seen by a physician assistant, nurse practitioner, doctor of osteopathic...Read More »

CMS clarifies guidance for resolving PTP edits and MUEs, reporting modifiers -59 and -91

Tue, 01/08/2019
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Revenue Integrity

CMS released additional instructions to the Medicare Claims Processing Manual for the accurate interpretation of claim edits and...Read More »

2019 MPFS: Review and refresh your processes

Thu, 01/03/2019
NAHRI Journal - Volume 3, Issue 1
Billing and Claims, Coding and Documentation, Reimbursement and Payment Methodologies, Revenue Integrity

Check your processes to implement E/M documentation changes, code updates, and expanded laboratory reporting requirements.Read More »

Site-neutral payment policies move ahead in 2019 OPPS final rule

Thu, 01/03/2019
NAHRI Journal - Volume 3, Issue 1
Billing and Claims, Coding and Documentation, Reimbursement and Payment Methodologies, Revenue Integrity

Understand how payment policy changes, C-APC changes, and more will impact your organization.Read More »

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