Coding and Documentation

In the 2022 NAHRI Leadership Council survey: Custom Edits—Creation and Workflow, 100 leaders, including revenue integrity, health information management (HIM), and coding directors and managers primarily from acute care hospitals and health systems with 500+ beds shared key insights into their custom edit processes, including workflow locations, oversight hierarchy, and the leading factors that drive custom edits.

Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-19-related billing flexibilities, and value-based care, according to the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule released July 7.

The American Medical Association’s (AMA) CPT Editorial Panel recently published changes to its evaluatio and management (E/M) Services Guidelines. The update includes code revisions, additions, and deletions, which are scheduled to take effect January 1, 2023.

Focus on the people and processes that make revenue integrity work.

Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI, shared three steps to a proactive revenue integrity department.

Consider how CMS’ proposed changes could affect reimbursement and revenue integrity operations.

Use these strategies to protect revenue and strengthen compliance with inpatient-only list requirements.

Apply these tips to reduce and prevent common denials due to medical necessity, the three-day payment window, and more.

Understand how to navigate evolving guidance on observation services and medical necessity.