Billing and reimbursement

A recent analysis of patient financial transactions from more than 800 hospitals noted performance disparities among managed care payers for revenue cycle key performance indicators where accounts receivable and denials are concerned.

Although every claim denial should be tracked, not every denial should be appealed. Learn about how and when to appeal Medicare claims denials. 

 Can a facility bill a cancelled inpatient-only procedure on Type of Bill 131 or does the patient type/status remain as inpatient with Type of Bill 111?

Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.

Documentation and coding based on time requires knowledge about the general principles of E/M documentation, common sets of codes used to bill for E/M services, and E/M services providers.

For the first time in over a decade, CMS has posted a decision memo with a 30-day public comment period for the National Coverage Determination on implantable cardioverter defibrillators.

CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November. 

We found out after an observation patient was discharged that one of the procedures performed was an inpatient-only procedure. Can we bill this to Medicare without an official inpatient order on the medical record?

The overall monthly national healthcare spending rate modestly increased 4.3% from August 2016 to August 2017, with a notable increase in home health spending, according to a brief from Altarum’s Center for Sustainable Health Spending.

U.S. District Court Judge Rudolph Contreras will hold a hearing December 21 for a lawsuit aimed at halting the CMS payment reduction for hospital outpatient drugs acquired through the 340B program, a policy set to go into effect January 1.