As CMS and third-party payers have looked for ways to treat patients in the outpatient setting and reduce inpatient volumes, CMS has used the 2-midnight rule, in addition to other methods, to treat patients as outpatients or in observation whenever possible.
The staff of Community Hospital Anderson in Anderson, Indiana, knows a thing or two about prioritization. Not having a separate department dedicated to revenue integrity, their staff balances their revenue cycle roles with their revenue integrity-specific projects.
The display copy of the Quality Payment Program proposed rule was released in June, and you can think of this rule as a companion to the Medicare Physician Fee Schedule that typically comes out with the OPPS rule. That means both rules need to be read, understood, and, ideally, commented on by providers.
Carolinas Healthcare System agreed to pay $6.5 million to settle allegations of a years-long practice of upcoding urine drug tests, the Office of Inspector General announced June 30.
When it comes to revenue integrity, new challenges arise daily, but SSM Health Cardinal Glennon Children’s Hospital in St. Louis has a revenue integrity department that’s been meeting them head on.
With healthcare billing growing in complexity each year, healthcare organizations must take extra steps to maximize reimbursement and maintain compliance.
The release of the Quality Payment Program proposed rule introduced virtual groups as a way to reduce burden on small practices and clinicians. While the MACRA legislation laid out the initial concept of virtual groups, this proposed rule revealed many more details about how virtual groups will function.
CMS has spoken repeatedly of easing the burden for providers this spring, and the agency’s Quality Payment Program (QPP) proposed rule released June 20 attempts to do that for small practices and other clinicians.
Prioritization and time management are crucial when it comes to leading a revenue integrity department. Kimberly Yelton, RHIA, CCS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, and director of revenue integrity at WakeMed Health & Hospitals in Raleigh, North Carolina, told NAHRI about her experience with this when planning and following through with department initiatives.
