Prior Authorization for Hospital Services: Utilization Control or Compliance Initiative?

Fri, 06/02/2023 - 16:38
Webinars
Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Policies and Procedures, Program Management, Revenue Integrity

Kimberly A. Hoy, JD, CPC, covers the ins and outs of the prior authorization program for hospital outpatient services.

Medicare Advantage and the 2-Midnight Rule: Level the Field With Medicare Advantage Payers

Fri, 06/02/2023 - 16:35
Webinars
Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Revenue Integrity

Jerilyn Morrissey, MD, clears up confusion about the regulations and explain how to determine when the 2-midnight rule applies to Medicare Advantage payers.

2023 E/M Updates For Coding: Straightforward or Highly Complex?

Tue, 05/30/2023 - 13:55
Webinars
Coding and Documentation, Revenue Integrity

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O, reviews newly reportable E/M codes, guideline changes, add-on codes, and deleted and revised codes.

CMS updates FAQ on PHE waivers and flexibilities

Wed, 05/24/2023
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, News, Policies and Procedures, Revenue Integrity

CMS recently updated an FAQ to clarify outpatient therapy and telehealth billing policies after the PHE conclusion.

CMS releases FAQ on waivers and flexibilities ahead of PHE conclusion

Wed, 05/10/2023
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, News, Policies and Procedures

The COVID-19 PHE is expected to conclude at the end of the day on May 11. To assist providers during this transition, CMS released an FAQ to clarify the expiration timelines for various Medicare waivers and flexibilities.

Navigating the end of PHE waivers and flexibilities on the April NAHRI Quarterly Call

Wed, 04/26/2023
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, Coverage, Monitoring and Audits, News, Program Management, Revenue Integrity

NAHRI members learned about the latest association news, tips for managing the unwinding of COVID-19 public health emergency (PHE) waivers, and more on the April 25 NAHRI Quarterly Call.

AMA approves new COVID-19 vaccine administration code

Wed, 04/26/2023
Revenue Integrity Insider
Coding and Documentation, News, Revenue Integrity

The American Medical Association’s (AMA) CPT Editorial Panel recently approved COVID-19 vaccine administration code 0174A.

2024 IPPS proposed rule: CMS mulls payment updates, codes changes

Wed, 04/12/2023
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Compliance, News, Reimbursement and Payment Methodologies, Revenue Integrity

CMS' fiscal year IPPS proposed rule includes proposals to increase hospital payments, ICD-10-CM/PCS code updates, and adjustments to new technology add-on payments. The proposed rule also covers potential updates to quality reporting and other programs.

Download the April 2023 issue of the NAHRI Journal

Wed, 04/12/2023
NAHRI Journal - Volume 7, Issue 2
Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

Map a course to revenue integrity success.

Significant Medicare PHE extensions and adjustments

Wed, 04/12/2023
NAHRI Journal - Volume 7, Issue 2
Billing and Claims, Coding and Documentation, Compliance, Coverage, Policies and Procedures, Reimbursement and Payment Methodologies, Revenue Integrity

Use these charts to identify extensions and end dates for COVID-19 public health emergency (PHE) waivers and flexibilities and effected services in hospitals, CAHs, RHCs, FQHCs, and physician services.

Pages