Wide variation in the cost of common diagnostic tests significantly contributes to healthcare cost inflation and standardizing prices could save billions annually, according to a recent UnitedHealth report.
The National Association of Healthcare Revenue Integrity (NAHRI) is pleased to announce Revenue Integrity Week, a national week of recognition for revenue integrity professionals, to be held June 3–7. This year’s theme is Scale New Heights: Elevate Your Profession and Career.
CMS modified its proposal to expand prior authorization and step therapy to protected classes of drugs for Part D and Medicare Advantage beneficiaries, according to a final rule released May 16.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about E/M code changes implemented this year and changes for implementation over the next two years.
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
U.S. District Judge Rudolph Contreras last week reaffirmed that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it made 2018 payment cuts to outpatient hospitals for certain drugs purchased through the 340B drug pricing program, and extended the ruling to 2019 payment cuts.
A recent MLN Matters article clarifies language in the Medicare Claims Processing Manual to match current documentation policy for evaluation and management (E/M) services billed by teaching physicians.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
