Tag: Healthcare Payment

outpatient Medicare claims

CMS Delays OPPS Claim Edits For Off-Campus Provider-Based Depts

OPPS claim edits slated to take effect this month will now start in October to give providers more take to adjust to billing changes for off-campus provider-based departments. CMS is postponing the implementation of outpatient prospective payment system (OPPS) claim edits that would require hospitals and health systems with multiple locations to list provider addresses […]
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Evaluation and Management Service Codes

AMA on Evaluation and Management Service Codes Guidelines for 2021

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management service codes (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated in their initiative that, although […]
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HCPCS Coding

CMS Announces HCPCS Coding, Coverage And Payment Initiatives To Improve Patient Access To New Technologies

On May 2, the Centers for Medicare and Medicaid Services (CMS or the Agency) announced in a press release that it will be changing how frequently the Agency reviews applications for new and revised Level II codes under the Healthcare Common Procedure Coding System (HCPCS). Specifically, CMS stated that the Agency “is moving to a process with […]
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Patient Financial Encounters

Customize Patient Financial Encounters For Revenue Cycle Success

Healthcare is a top priority for American voters and there aren’t dramatic differences by ideology, according to a new survey. Adopted from the marketing industry, customer segmentation allows health systems to further customize the patient financial experience and help them get paid. Key Takeaways Tailor billing strategies and patient payment options to a financial situation […]
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Clinical Denials

Clinical Denials: Prevention Is The Best Medicine

Clinical denials are a fact of life for hospitals. Providers must contend with a number of government audits conducted by several different organizations. On the private payer side, hospitals must comply with complex approval processes related to prior authorizations, admission status and medical necessity. At Becker’s Hospital Review’s 10th Annual Meeting in Chicago, R1 RCM hosted a […]
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PSYCHIATRIC FACILITIES PAYMENTS

Psychiatric Facilities Could See Payments of $75 Million In 2020

CMS has released the inpatient psychiatric facility proposed rule. Approximately $75million is projected to be paid to inpatient psychiatric facilities (IPF), according to the Centers for Medicare & Medicaid Services (CMS) proposed 2020 inpatient prospective payment system (IPPS) released on April 19. IPF-PPS applies to inpatient services for psychiatric hospitals and distinct psychiatric units of […]
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Top 13 Reasons For Claim Denials

Top 13 Reasons For Claim Denials

Denied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a smoother revenue cycle and find greater financial success. Here are the 13 most common reasons for why claims […]
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Blockchain in Healthcare

How Blockchain Can Solve Healthcare’s Data Reconciliation Problem

The U.S. healthcare industry has a $1 trillion opportunity to cut costs and reduce waste, according to a 2015 Harvard Business Review analysis. While there are various areas waste accumulates, costly data reconciliation is a prominent problem for hospitals and health systems. Change Healthcare defines data reconciliation as “the process of compiling information across companies […]
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