Q: We're seeing a significant increase in pre-payment audit activity. How can we adapt our audit and denial management processes to cope with this shift?
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
The 2021 OPPS final rule, released December 2, doesn’t pack many surprises, with CMS generally finalizing most policies as proposed or choosing to continue with current policies. This should aid hospitals required to implement many of its policies in just a few short weeks due to the pandemic-disrupted rulemaking cycle.
Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. Use these tips to create a multidisciplinary strategy that gives you a clear view into processes.
The HIM department plays a critical role in the revenue cycle, but it’s often placed in a reactive position, limiting its effectiveness. Learn how to improve operations by enhancing the HIM department’s involvement across the revenue cycle.
