Study shows higher upcoding rates in outpatient settings

Wed, 05/21/2025
Revenue Integrity Insider
Billing and Claims, Coding and Documentation, Denials and Appeals, Monitoring and Audits, News, Revenue Integrity

New findings suggest upcoding is becoming a more common practice in emergency departments, urgent care centers, and physician offices. 

How to respond to commercial payer line item denials

Fri, 05/16/2025
Leadership Council Insider
Billing and Claims, Chargemaster and Charge Capture, Denials and Appeals, NAHRI Leadership Council, Revenue Integrity

When organizations receive a charge denial from a commercial payer, they must weigh their options to determine whether challenging the decision wil

Tackling the Denials Challenge: Smarter Strategies, Stronger Defenses

Wed, 05/14/2025 - 14:06
Council Resources
Denials and Appeals, NAHRI Leadership Council, Policies and Procedures, Program Management, Revenue Integrity

Hospitals aren’t just reacting to denials anymore—they’re redesigning the playbook. As commercial and Medicare Advantage (MA) denials grow more complex, organizations are taking strategic, cross-functional approaches to manage them. Revenue integrity teams are leveraging analytics to detect...

Tackling medical necessity denials

Wed, 05/07/2025
Revenue Integrity Insider
Denials and Appeals, Revenue Integrity

Learn how to reduce medical necessity denials by developing a strong partnership with clinical teams.

2025 Research Series Panel Discussion Part 2 (April 17)

Wed, 04/23/2025 - 12:20
Council Resources
Denials and Appeals, Program Management, Revenue Integrity

Q&A: Preventing sepsis denials

Wed, 04/23/2025
Revenue Integrity Insider
Ask NAHRI, Coding and Documentation, Denials and Appeals, Revenue Integrity

Q: If a provider documents sepsis with acute kidney injury but does not explicitly link the two conditions, should they be queried to prevent the claim from being denied?

2025 State of the Revenue Integrity Industry Webinar

April 10, 2025
Webinars
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Revenue Integrity

Join NAHRI and our panel of revenue integrity leaders and experts on June 4 from 1 to 2 p.m. Eastern to learn what ingredients you need for a recipe for revenue integrity success! Using the data from NAHRI's 2025 State of the Revenue Integrity Industry Survey, we'll discuss current and upcoming...

Top Six Trends for Healthcare Revenue Cycle

Wed, 04/09/2025 - 13:57
White Papers
Billing and Claims, Denials and Appeals, Program Management, Revenue Integrity

What are the top trends in healthcare RCM for 2025?

Unlock six top priorities as identified by 600 healthcare and finance leaders

The healthcare revenue cycle is always changing. As organizations navigate challenges like higher denial rates, payer changes, and data security risks,...

CMS issues CY 2026 MA and Part D final rule, rate announcement

Wed, 04/09/2025
Revenue Integrity Insider
Coverage, Denials and Appeals, News, Reimbursement and Payment Methodologies, Revenue Integrity

Assess key policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year (CY) 2026.

Download the April 2025 issue of the NAHRI Journal

Wed, 04/02/2025
NAHRI Journal - Volume 9, Issue 2
Billing and Claims, Chargemaster and Charge Capture, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

Create your recipe for revenue integrity success.

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