The session I’m most looking forward to presenting at NAHRI's 2018 Revenue Integrity Symposium is “Next Generation Technologies: Practical Guidance for Success” because I really want to help demystify what appears to be misinformation, miscommunication, and perhaps just an overall lack of understanding about how CMS’ formulas for outliers and NTAP work. I also want to help clarify how what providers report today impacts payment rates two years down the road.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
Without the guidance and expertise of compliance, revenue can’t be considered truly accurate and audit-proof. By using a compliance work plan to weave compliance best practices and audit findings into revenue integrity, organizations can flip revenue integrity processes from reactive to proactive.
The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule, released July 12, introduces policies that focus on expanding the framework for reporting E/M visits and removing certain process measures under the Quality Payment Program (QPP).
