Compliance

Brush up on the most recent changes to Medicare’s prior authorization requirements and their operational impact.

Consider how revenue integrity and utilization review teams can work together to meet shared goals.

Gain a fresh perspective on methods to efficiently address patient status changes.

Consider these case studies to understand how to apply condition codes 44 and W2.

Learn how to use regular internal audits and monitoring to boost compliance in revenue integrity areas.

Most hospitals are noncompliant with CMS’ Hospital Price Transparency final rule, according to a study published June 14 in JAMA. Out of a random sample of 100 hospitals, 83 were noncompliant with at least one significant requirement.

CMS boosted Medicare payment for COVID-19 vaccines administered in the patient’s home to $75 per dose, the agency announced June 9. Prior to June 9, Medicare paid $40 per dose for COVID-19 vaccines administered in the patient’s home.

Jugna J. Shah, MPH, CHRI, discusses why innovative therapies and technologies call for innovations in existing coding, billing, and reimbursement models.

Ronald Hirsch, MD, FACP, CHCQM, CHRI, examines recent changes to commercial payer prior authorization requirements and how it affects revenue integrity.

Amy Tepp, CPA, reflects on how key traits of revenue integrity departments—dedication and teamwork—have helped the profession adapt in an evolving industry.